Hemodynamic Changes with Umbilical Cord Milking in Nonvigorous Newborns: A Randomized Cluster Cross-over Trial.
Hemodynamic Changes with Umbilical Cord Milking in Nonvigorous Newborns: A Randomized Cluster Cross-over Trial.
复制标题
无活力新生儿脐带挤奶的血流动力学变化：随机集群交叉试验。
DOI：
10.1016/j.jpeds.2023.03.001
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Singh,Yogen
中科院分区：
文献类型：
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作者：
Katheria,Anup;Mercer,Judith;Poeltler,Deb;Morales,Ana;Torres,Nohemi;Lakshminrusimha,Satyan;Singh,Yogen
ObjectiveTo assess the hemodynamic safety and efficacy of umbilical cord milking (UCM) compared with early cord clamping (ECC) in nonvigorous newborn infants enrolled in a large multicenter randomized cluster-crossover trial.Study designTwo hundred twenty-seven nonvigorous term or near-term infants who were enrolled in the parent UCM vs ECC trial consented for this substudy. An echocardiogram was performed at 12 ± 6 hours of age by ultrasound technicians blinded to randomization. The primary outcome was left ventricular output (LVO). Prespecified secondary outcomes included measured superior vena cava (SVC) flow, right ventricular output (RVO), peak systolic strain, and peak systolic velocity by tissue Doppler examination of the RV lateral wall and the interventricular septum.ResultsNonvigorous infants receiving UCM had increased hemodynamic echocardiographic parameters as measured by higher LVO (225 ± 64 vs 187 ± 52 mL/kg/min;P< .001), RVO (284 ± 88 vs 222 ± 96 mL/kg/min;P< .001), and SVC flow (100 ± 36 vs 86 ± 40 mL/kg/min;P< .001) compared with the ECC group. Peak systolic strain was lower (−17 ± 3 vs −22 ± 3%;P< .001), but there was no difference in peak tissue Doppler flow (0.06 m/s [IQR, 0.05-0.07 m/s] vs 0.06 m/s [IQR, 0.05-0.08 m/s]).ConclusionsUCM increased cardiac output (as measured by LVO) compared with ECC in nonvigorous newborns. Overall increases in measures of cerebral and pulmonary blood flow (as measured by SVC and RVO flow, respectively) may explain improved outcomes associated with UCM (less cardiorespiratory support at birth and fewer cases of moderate-to-severe hypoxic ischemic encephalopathy) among nonvigorous newborn infants.
