Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2017 Jan 25:5:1.
doi: 10.3389/fped.2017.00001. eCollection 2017.

Providing a Placental Transfusion in Newborns Who Need Resuscitation

Anup C Katheria  1 , Melissa K Brown  1 , Wade Rich  1 , Kathy Arnell  1
Affiliations
Review

Providing a Placental Transfusion in Newborns Who Need Resuscitation

Anup C Katheria et al. Front Pediatr. .

Abstract

Over the past decade, there have been several studies and reviews on the importance of providing a placental transfusion to the newborn. Allowing a placental transfusion to occur by delaying the clamping of the umbilical cord is an extremely effective method of enhancing arterial oxygen content, increasing cardiac output, and improving oxygen delivery. However, premature and term newborns who require resuscitation have impaired transitional hemodynamics and may warrant different methods to actively provide a placental transfusion while still allowing for resuscitation. In this review, we will provide evidence for providing a placental transfusion in these circumstances and methods for implementation. Several factors including cord clamping time, uterine contractions, umbilical blood flow, respirations, and gravity play an important role in determining placental transfusion volumes. Finally, while many practitioners agree that a placental transfusion is beneficial, it is not always straightforward to implement and can be performed using different methods, making this basic procedure important to discuss. We will review three placental transfusion techniques: delayed cord clamping, intact umbilical cord milking, and cut-umbilical cord milking. We will also review resuscitation with an intact cord and the evidence in term and preterm newborns supporting this practice. We will discuss perceived risks versus benefits of these procedures. Finally, we will provide key straightforward concepts and implementation strategies to ensure that placental-to-newborn transfusion can become routine practice at any institution.

Keywords: blood volume; cord milking; delayed cord clamping; hypovolemia; neonatal transition; perfusion; placental transfusion; resuscitation.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Lifestart™ bed equipped with resuscitation equipment.
Figure 2
Figure 2
Personnel and equipment arrangement for neonatal resuscitation with an intact umbilical cord. (A) Operating room and (B) labor and delivery suite.
See this image and copyright information in PMC

References

    1. Brady JP, James LS. Heart rate changes in the fetus and newborn infant during labor, delivery, and the immediate neonatal period. Am J Obstet Gynecol (1962) 84:1–12.10.1016/0002-9378(62)90663-4 - DOI - PubMed
    1. Yao AC, Moinian M, Lind J. Distribution of blood between infant and placenta after birth. Lancet (1969) 2:871–3.10.1016/S0140-6736(69)92328-9 - DOI - PubMed
    1. Bhatt S, Alison BJ, Wallace EM, Crossley KJ, Gill AW, Kluckow M, et al. Delaying cord clamping until ventilation onset improves cardiovascular function at birth in preterm lambs. J Physiol (2013) 591:2113–26.10.1113/jphysiol.2012.250084 - DOI - PMC - PubMed
    1. Yao AC, Lind J. Effect of gravity on placental transfusion. Lancet (1969) 2:505–8.10.1016/S0140-6736(69)90213-X - DOI - PubMed
    1. Vain NE, Satragno DS, Gorenstein AN, Gordillo JE, Berazategui JP, Alda MG, et al. Effect of gravity on volume of placental transfusion: a multicentre, randomised, non-inferiority trial. Lancet (2014) 384:235–40.10.1016/S0140-6736(14)60197-5 - DOI - PubMed

LinkOut - more resources