Effects Of Placental Transfusion Research Articles

Effect of Placental Transfusion on Long-Term Neurodevelopmental Outcomes in Premature Infants: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

BackgroundThe pathophysiology and the potential risks of placental transfusion (PT) differ substantially in preterm infants, necessitating specific studies in this population. This study aimed to evaluate the safety and efficacy of PT in preterm infants from the perspective of long-term neurodevelopmental outcomes. MethodsWe conducted a systematic literature search using placental transfusion, preterm infant, and its synonyms as search terms. Cochrane Central Register of Controlled Trials, Medline, and Embase were searched until March 07, 2023. Two reviewers independently identified, extracted relevant randomized controlled trials, and appraised the risk of bias. The extracted studies were included in the meta-analysis of long-term neurodevelopmental clinical outcomes using fixed-effects models. ResultsA total of 5612 articles were identified, and seven randomized controlled trials involving 2551 infants were included in our meta-analysis. Compared with immediate cord clamping (ICC), PT may not impact adverse neurodevelopment events. No clear evidence was found of a difference in the risk of neurodevelopmental impairment (risk ratio [RR]: 0.89, 95% confidence interval [CI]: 0.76 to 1.03, P = 0.13, I2 = 0). PT was not associated with the incidence of cerebral palsy (RR: 1.23, 95% CI: 0.59 to 2.57, P = 0.79, I2 = 0). Analyses showed no differences between the two interventions in cognitive, language, and motor domains of neurodevelopment. ConclusionsFrom the perspective of long-term neurodevelopment, PT at preterm birth may be as safe as ICC. Future studies should focus on standardized, high-quality clinical trials and individual participant data to optimize cord management strategies for preterm infants after birth.

The effects of placental transfusion on mothers

Objective While there is ample evidence supporting delayed cord clamping (DCC) in neonates, the data on the maternal outcomes related to DCC are relatively sparse. Moreover, the outcomes, such as postpartum hemorrhage (PPH), were mostly reported for uncomplicated term vaginal deliveries. The objective of this study was to present the two primary maternal outcomes, incidence of PPH and change in hematocrit pre- and post-delivery in complex situations of preterm deliveries and term cesarean sections. Study design Maternal data were collected prospectively since the placental transfusion process was implemented in a step-wise fashion in our delivery hospitals, starting August, 2013. These data on very preterm singleton, moderate preterm, very preterm twin gestation, late preterm deliveries and term cesarean sections with DCC or umbilical cord milking (UCM) were compared with respective retrospective cohorts of deliveries in which immediate cord clamping (ICC) was performed. Results Comparing very preterm singleton deliveries, the incidence of PPH was similar between the ICC and DCC groups (2.3% vs. 1.7%). There was no significant difference in mean hematocrit change pre- and postdelivery (3.06 ± 1.32 vs. 3.47 ± 1.52). When 45 s DCC cohort was compared with 60 s DCC cohort, there were no significant differences in the incidence of PPH (1.7% vs. 4.8%) or the hematocrit change pre- and postdelivery (3.47 ± 1.52 vs. 4.32 ± 1.88). PPH was not observed in either group when comparing retrospective ICC cohort with prospective DCC cohort with 60 s delay in very preterm twin gestation deliveries. There was no significant difference between the mean hematocrit change pre- and postdelivery (5.5 ± 3.3 vs. 5.8 ± 3.9). When moderate and early late preterm deliveries between 32° to 346 weeks of gestation were compared, there were no differences between the incidence of PPH (0.9% vs. 0%) or hematocrit change pre- and postdelivery (4.2 ± 2.3 vs. 4.8 ± 2.9). Comparing late preterm deliveries between 35° and 366 weeks of gestation, there was no significant difference in the incidence of PPH (13% vs. 11.4%) or the mean hematocrit change pre- and postdelivery (5.0 ± 3.0 vs. 5.1 ± 2.8). In term cesarean deliveries, the incidence of PPH was 2.2% in the retrospective ICC group and 1.4% in the prospective UCM group. There was no difference in mean hematocrit change pre- and postdelivery (5.9 ± 3.7 vs. 6.2 ± 2.8). Conclusion DCC or UCM was not associated with the increased risk for PPH or significant change in maternal hematocrit pre- and postdelivery in very preterm singleton, moderate preterm, very preterm twin gestation, late preterm deliveries and term cesarean sections.

Effects of Placental Transfusion on Late Preterm Infants Admitted to a Mother-Baby Unit

Effects of Placental Transfusion on Late Preterm Infants Admitted to a Mother-Baby Unit

Functional echocardiographic evaluation of the effect of placental transfusion in full-term newborns who need resuscitation

Background At the time of delivery, newborn babies have to pass through transitional changes in many of their life supporting systems. A more successful transition at the level of the cardiovascular system, hence an overall better transition, could be reached if placental transfusion is implicated. Aim To study the feasibility of doing intact umbilical cord milking (I-UCM) as a method of placental transfusion in term neonates who were born depressed and needed resuscitation and to study its hemodynamic effects using echocardiography. Patients and methods A randomized controlled study involving 66 patients over a period of 6 months was conducted. The studied population was assigned to receiving I-UCM or immediate cord clamping. Laboratory parameters, resuscitation interventions, and finally, functional echocardiographic were studied in both groups. Results It was feasible to perform I-UCM in the delivered babies in the assigned group. Such group was found to have faster time for the first breath (45 vs. 60 s), higher Apgar score (5, 8, 10 vs. 4, 7, 9), and no need for more advanced resuscitation interventions compared with the group with immediate cord clamping. Higher levels of hemoglobin (17.20 vs. 15.85) were noticed with less need to transfusion in the intervention group. Better echocardiographic assessments were shown regarding ejection fraction, tricuspid annular plane systolic excursion, and lower incidence of pulmonary hypertension in the I-UCM group (70 vs. 66%, 1.02 vs. 0.87 cm, and 33.3 vs. 62.5%, respectively). Conclusions The practicality of UCM was easy and feasible in both depressed and nondepressed newborns. UCM as a method for placental does not affect resuscitative measures and results in better cardiac performance in asphyxiated babies.

Effects of placental transfusion on neonatal circulation stability

Delayed umbilical cord clamping and umbilical cord milking could promote blood flowing from the placenta to the newborn, which would increase neonatal blood volume, avoid suddenly cardiac preload changes caused by the interruption of placental transfusion at birth, and make the neonatal cardiovascular system transition more stable and physiological.Although there have been cases of neonatal jaundice and polycythemia caused by placental transfusion in clinical, studies have shown that placental transfusion does not increase the incidence.At present, umbilical cord clamping immediately after birth is the commonly clinical practice in most countries, including China.The method of umbilical cord clamping, the factors effecting placental transfusion and the pros and cons of placental transfusion still need further research. Key words: Placental transfusion; Umbilical cord clamping; Neonatal circulation

Effect of placental transfusion on neonatal resuscitation attempts

Objective: Overall, neonatal mortality has been shown to be reduced by: placental transfusion (the transfer of blood from the placenta to the neonatal circulation after birth); delayed cord clamping (DCM) (waiting for the umbilical cord to stop pulsating before clamping and cutting the cord); and umbilical cord milking (UCM) (clamping and cutting the cord immediately before milking the cord towards the neonate to expel remaining volume). This systematic review aimed to determine whether placental transfusion negatively impacts resuscitation by delaying it or has any effect on infant mortality, and to identify any barriers to performing it. Methods: CINAHL, MEDLINE, AMED and the British Nursing Index were searched using key terms to identify relevant English language publications between 2017 and 2019. Results: Five papers were selected for critical analysis—three randomised control trials and two cohort studies. Conclusion: Placental transfusion was not found to have a negative impact on neonatal resuscitation but, equally, had no significant effect on Apgar at 5 minutes; however, Apgar is a crude measure of infant mortality. The question remains around the proven multifaceted benefit of placental transfusion in the prehospital environment, which requires further research. There is evidence to suggest prehospital clinicians should be looking to change practice. Further research, considerations and consultations are required to ascertain the best way to implement the procedure with a balanced and proportionate approach considering neonatal thermoregulation and maternal management. The main reported barrier to placental transfusion was a lack of appropriate equipment.

The Effects of Placental Transfusion on 12‐Month Brain Myelin Content in Term Infants: A Randomized Controlled Trial

IntroductionImmediate cord clamping (ICC) continues to be the standard practice in the United States. This results in leaving about 30% of the fetal‐placental iron‐rich blood behind in the placenta and puts an infant at risk for lower iron stores. Evidence (animal and human) suggests iron is critical to early brain white matter development as it plays a significant role in myelin formation. The purpose of this study was to determine, at 12 months of age, if infants who received a full placental transfusion at birth differ in myelin content and developmental outcomes compared to infants who received no placental transfusion. The hypothesis was that healthy, term infants who received a full placental transfusion via delayed cord clamping (DCC) will have greater brain myelin content and better neurodevelopmental outcomes compared to infants who received no placental transfusion (ICC) at 12 months of age.MethodsSeventy‐three term pregnant women with singleton fetuses were enrolled in a prospective randomized controlled trial and randomized to either ICC (< 20 s) or DCC (≥ 5 min). At 4 and 12 months, the infants’ hemoglobin and ferritin levels were measured, and the infants underwent a non‐sedated MRI and neurodevelopmental testing.ResultsMaternal and infant demographics were not different between groups. Mean (SD) cord clamping time was 318 (158) seconds in the DCC group versus 10 (5) seconds in the ICC group (P < .0001). At 4 months, infants who received DCC had higher ferritin levels (91 [57] vs 61 [30] ng/mL, P < .04). At 12 months, infants randomized to DCC had significantly greater brain myelin content in the following brain regions: left and right (R) internal capsule, R parietal, R occipital, R frontal, and R orbital areas. The DCC group had a slightly higher social‐emotional performance than the ICC group using the BITSEA Competence score (17 [3] vs 15 [3], P = .08). No differences were seen in ferritin or hemoglobin levels between groups at 12 months.DiscussionAt 12 months, placental transfusion at birth appears to increase brain myelin content in regions involving motor and visual/spatial pathways and sensory processing. Neurodevelopmental testing suggests a trend of better social‐emotional outcomes associated with DCC. In conclusion, the endowment of iron‐rich blood obtained through DCC may offer a longitudinal advantage for early white matter development in the brain.

Effects of Placental Transfusion by Delayed Cord Clamping or Umbilical Cord Milking versus Immediate Cord Clamping on Neonatal Outcomes in Very Low Birth Weight Neonates

Background: Delayed cord clamping (DCC) and umbilical cord milking (UCM) are two recently advocated interventions to enhance placental transfusion at birth. DCC and MCM might increase blood volume and help neonates to transition from fetal to neonatal circulation. Objective: To evaluate the effects of delayed cord clamping (DCC), umbilical cord milking (UCM), and immediate cord clamping (ICC) on very low birth weight (VLBW) neonates. Methods: At our institution, ICC was routinely done until December, 2012 when it was replaced by DCC. UCM was implemented in March, 2015. Neonatal outcomes were compared among ICC, DCC, and UCM. Results: A total of 94 neonates met inclusion criteria. Comparing with ICC neonates, DCC and UCM neonates had higher hematocrits, fewer blood transfusions, and lower incidence of chronic lung disease at 36 completed weeks of gestation. All groups were similar in APGAR scores, vasopressor use, intraventricular hemorrhage (IVH) and necrotizing enterocolitis (NEC). Conclusion: Compared to ICC, DCC and UCM appear to be more beneficial to VLBW neonates without apparent adverse risks.

The Effects of Placental Transfusion on Placental Residual Blood Volume and 24 to 48‐hour Hemoglobin and Serum Bilirubin in Term Newborns: A Randomized Controlled Trial

PurposeTo determine if newborns who receive a full placental transfusion at birth differ in placental residual blood volume (PRBV) and 24 to 48‐hour hemoglobin (Hb) and total serum bilirubin (TSB) levels compared to newborns who receive no placental transfusion.Research QuestionWill newborns who receive a full placental transfusion have less PRBV, a higher 24 to 48‐hour Hb, and no difference in peak TSB compared to newborns who receive no placental transfusion?SignificanceThe usual maternity care practice in the United States is to immediately clamp the umbilical cord (immediate cord clamping [ICC]) at the time of birth. When ICC occurs, 20% to 40% of the fetal‐placental blood volume (containing iron‐rich red blood cells) is left behind in the placenta, potentially leading to lower iron stores in infancy.MethodsA prospective randomized controlled trial was conducted. Seventy‐three healthy term pregnant women with singleton fetuses were enrolled. At birth, they were randomized to either ICC (<20 seconds; n = 36) or delayed cord clamping (DCC) (≥5 minutes; n = 37) and then placed skin‐to‐skin. The primary endpoints were PRBV in mL/kg, Hb (g/dL), and peak TSB at 24 to 48 hours of age. Primary analyses were conducted by intention‐to‐treat and secondary analyses by actual treatment.ResultsMaternal and newborn demographics were not significantly different between groups. Mean (standard deviation [SD]) cord clamping time was 303 (121) seconds (DCC) versus 10 (6) (ICC) seconds (P = .001). Eleven newborns received cord milking as a proxy for DCC at the time of cesarean birth or when resuscitation measures were indicated. There were 9 protocol violations. Newborns randomized to DCC left behind less PRBV (20.0 vs 30.8 mL/kg, P < .001). At 24 to 48 hours of age, newborns exposed to DCC had significantly higher Hb levels (19.5 vs 17.7 g/dL, P = .002) without a difference in peak TSB levels (DCC = 8.5 vs ICC = 9.0 mg/dL, P = .45) compared to infants with ICC. Two newborns in each group had phototherapy.DiscussionNewborns with ICC left behind more PRBV and had lower Hb levels at 24 to 48 hours. There was no difference between the groups on peak TSB levels or other indicators of hyperbilirubinemia. The results support the early hematological advantage of DCC while demonstrating no association with an increase in hyperbilirubinemia.

Unusual Twinning Resulting in Chimerism: A Systematic Review on Monochorionic Dizygotic Twins

Traditionally, it is understood that dizygotic (DZ) twins always have a dichorionic placenta. However, with 8% blood chimerism in DZ twins, placental sharing is probably more common than previously has been recognized. In this article, we will review all available cases of monochorionic dizygotic (MCDZ) twins. A total of 31 twins have been described in literature. A monochorionic diamniotic placenta is reported in all cases. Assisted reproductive technology is responsible for the origin of the pregnancy in 82.1% of the cases. In 15.4% of the sex-discordant twins, a genital anomaly was reported in one of the twins. Chimerism is demonstrable in 90.3% of the twins, leading to various diagnostic difficulties. As this review shows that most MCDZ twins are discovered by accident, it can be argued that it is far more common than has been assumed until now. However, the prevalence is still unclear. Awareness of MCDZ twinning is important, with subsequently correct medical strategies. Similarly, the resulting (blood) chimerism is essential to consider in diagnostic procedures, pre- and postnatally. More research on the effect of placental transfusion between sex-discordant twins is required.

Effects of placental transfusion in extremely low birthweight infants: meta-analysis of long- and short-term outcomes.

Risks and benefits of increasing placental transfusion in extremely preterm infants (extremely low birthweight [ELBW], <1000 g) are ill defined. We performed a meta-analysis to compare long- and short-term outcomes of ELBW infants in trials of enhanced placental transfusion regimens. We conducted a meta-analysis of randomized controlled trials (RCTs) of delayed umbilical cord clamping or umbilical cord milking in compliance with PRISMA and Cochrane Collaborative guidelines for systematic reviews. We searched multiple databases for medical literature up to December 2012. Inclusion criteria were preterm infants less than 30 weeks and less than 1000 g birthweight, randomly assigned to enhanced placental transfusion (either delayed cord clamping or cord milking) versus immediate cord clamping. The primary outcome was standardized neurodevelopmental outcome at 18 to 24 months corrected age using a standardized scale. Several short-term outcomes were also evaluated as secondary variables. We found 19 studies of which 10 studies could be included (n = 199). Three reported neurodevelopmental outcomes, none of which showed significant rates of disability. Two reported these at 18 to 24 months (n = 42) but used different scales preventing pooling. Short-term benefits of enhanced placental strategies included better blood pressure and hemoglobin on admission, along with reduced blood transfusions, a trend to reduced intraventricular hemorrhage, and episodes of late-onset sepsis. Strategies to enhance placental transfusion may improve short-term outcomes of ELBW infants. However, paucity of data on neurodevelopmental outcomes and safety concerns tempers enthusiasm for these interventions. Appropriately designed RCTs to assess short-term and longterm outcomes are needed in ELBW infants.

Historical Perspectives

When neonatology was emerging as a clinical discipline in the late 1950s and early 1960s, it had the advantage of a strong foundation of basic research in fetal and neonatal physiology. In particular, the new clinical enterprise (it was not yet a subspecialty) focused on cardiorespiratory pathophysiology. This foundation came from a few distinguished research laboratories studying fetal and neonatal physiology and the processes of the transition from fetal to neonatal life. The preeminent laboratory in the field was the Nuffield Institute for Medical Research at Oxford, directed by Geoffrey S. Dawes. Geoffrey Dawes became the director of the Institute in 1948. He received his medical degree in 1943, and in the following 5 years, he gained recognition as a prominent investigator in pharmacology and physiology. The very short interval between receiving his degree and being named director of an important research institute indicates how quickly the academic leadership recognized his exceptional qualities. As the new director, Dawes set the primary focus of research for the Nuffield Institute as developmental physiology. In this role, the Nuffield became the successor to the path of research started by Sir Joseph Barcroft at Cambridge early in the twentieth century. Dawes and his coinvestigators concentrated particularly on the preparations for and mechanisms of adaptation to extrauterine life. A central focus of the research was the adaptive mechanisms in the circulatory and respiratory systems, including placental function, establishment of lung function, and changes in the pulmonary and systemic circulations. Although most of the work examined cardiorespiratory physiology and its neurohumoral regulation, researchers also studied fetal growth and metabolism, and their studies included the responses to stresses such as hypoxia and hemorrhage. One of the hallmarks of the research of this highly productive group was the elegance of their experimental designs. The clinical implications of this …

Anemia in Preterm Infants

During fetal life, hemoglobin concentration increases from a level of 9 g/dL at l0 weeks' to 14 to 15 g/dL at 22 to 24 weeks' gestation. By the middle of the third trimester, concentrations close to those observed at birth (16 to 17 g/dL) are reached, and little additional change occurs. As a result, cord hemoglobin concentrations in term and preterm newborns are very similar, with the possible exception of the most extremely preterm infants. Immediately after birth, the hemoglobin concentration begins to rise from the combined effects of placental transfusion and the postnatal readjustment of plasma volume. At approximately 8 to 12 hours of life, the hemoglobin plateaus at levels 1 to 2 g/dL above those observed at birth (about 18 g/dL).

Anemia in preterm infants.

During fetal life, hemoglobin concentration increases from a level of 9 g/dL at l0 weeks9 to 14 to 15 g/dL at 22 to 24 weeks9 gestation. By the middle of the third trimester, concentrations close to those observed at birth (16 to 17 g/dL) are reached, and little additional change occurs. As a result, cord hemoglobin concentrations in term and preterm newborns are very similar, with the possible exception of the most extremely preterm infants. Immediately after birth, the hemoglobin concentration begins to rise from the combined effects of placental transfusion and the postnatal readjustment of plasma volume. At approximately 8 to 12 hours of life, the hemoglobin plateaus at levels 1 to 2 g/dL above those observed at birth (about 18 g/dL).

Electron Microscopy of Cutaneous Capillaries of Newborn Infants: Effects of Placental Transfusion

Two hundred and ten capillaries taken by punch biopsy at 2 to 5 hours of age from term, normal, newborn infants were examined by electron microscopy. Six infants had early cord clamping and five had late cord ligation. In the late-clamped group, the capillaries were more distended morphologically as shown by a smaller endothelial index (endothelial area/total capillary area). In comparison to the early-clamped group, the late-clamped infants also had a larger number of fenestrated small blood vessels. Since fenestration is an anatomical structure related to rapid fluid exchange, it is suggested that this finding is an indication of a more active fluid transudation from the intravascular to the extravascular compartment in the late-clamped infants in response to a greater circulatory volume deriving from placental blood transfusion at birth. It is also suggested that the large number of fenestrated vessels in the late-clamped infants is a result of an increased number of openings of arteriovenous communications.