Delayed Umbilical Cord Clamping After Birth: ACOG Committee Opinion, Number 814.
Delayed Umbilical Cord Clamping After Birth: ACOG Committee Opinion, Number 814.
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DOI：
10.1097/aog.0000000000004167
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发表时间：
2020-12-01
影响因子：
7.2
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中科院分区：
文献类型：
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延迟脐带钳夹似乎对足月儿和早产儿有益。在足月婴儿中，延迟脐带夹紧会增加出生时的血红蛋白水平，并在生命的前几个月内改善铁储存，这可能对发育结果产生有利影响。在延迟脐带夹紧的足月儿中，需要光疗的黄疸发生率略有增加。因此，妇产科医生和其他产科护理提供者采用延迟脐带夹紧足月婴儿应确保机制到位，以监测和治疗新生儿黄疸。在早产儿中，延迟脐带夹紧与显著的新生儿益处相关，包括改善过渡性循环，更好地建立红细胞体积，减少输血需求，以及降低坏死性小肠结肠炎和脑室内出血的发生率。延迟脐带夹紧与产后出血风险增加或分娩时失血量增加无关，也与产后血红蛋白水平差异或输血需求无关。考虑到对大多数新生儿的好处以及与其他专业组织的一致性，美国妇产科医师学会现在建议在出生后至少30-60秒内延迟对活跃的足月和早产儿进行脐带夹紧。提供延迟脐带夹紧的能力可能因机构和环境而异;在这些情况下，最好由照顾母婴二人组的团队做出决定。
Delayed umbilical cord clamping appears to be beneficial for term and preterm infants. In term infants, delayed umbilical cord clamping increases hemoglobin levels at birth and improves iron stores in the first several months of life, which may have a favorable effect on developmental outcomes. There is a small increase in the incidence of jaundice that requires phototherapy in term infants undergoing delayed umbilical cord clamping. Consequently, obstetrician-gynecologists and other obstetric care providers adopting delayed umbilical cord clamping in term infants should ensure that mechanisms are in place to monitor and treat neonatal jaundice. In preterm infants, delayed umbilical cord clamping is associated with significant neonatal benefits, including improved transitional circulation, better establishment of red blood cell volume, decreased need for blood transfusion, and lower incidence of necrotizing enterocolitis and intraventricular hemorrhage. Delayed umbilical cord clamping was not associated with an increased risk of postpartum hemorrhage or increased blood loss at delivery, nor was it associated with a difference in postpartum hemoglobin levels or the need for blood transfusion. Given the benefits to most newborns and concordant with other professional organizations, the American College of Obstetricians and Gynecologists now recommends a delay in umbilical cord clamping in vigorous term and preterm infants for at least 30-60 seconds after birth. The ability to provide delayed umbilical cord clamping may vary among institutions and settings; decisions in those circumstances are best made by the team caring for the mother-infant dyad.