Clinical aspects of incorporating cord clamping into stabilisation of preterm infants

Abstract

Fetal to neonatal transition is characterised by major pulmonary and haemodynamic changes occurring in a short period of time. In the international neonatal resuscitation guidelines, comprehensive recommendations are available on supporting pulmonary transition and delaying clamping of the cord in preterm infants. Recent experimental studies demonstrated that the pulmonary and haemodynamic transition are intimately linked, could influence each other and that the timing of umbilical cord clamping should be incorporated into the respiratory stabilisation. We reviewed the current knowledge on how to incorporate cord clamping into stabilisation of preterm infants and the physiological-based cord clamping (PBCC) approach, with the infant's transitional status as key determinant of timing of cord clamping. This approach could result in optimal timing of cord clamping and has the potential to reduce major morbidities and mortality in preterm infants.

Keywords: neonatology; physiology; resuscitation.

Figure 1

Specially designed new resuscitation table, including the platform for the infant, which can be turned above the mother’s pelvis. The table is fully equipped to provide complete standard care and has a respiratory function monitor built in.

Figure 2

Respiratory function monitor depicting the respiratory function, oxygen saturation and heart rate; thus, providing feedback on the infant’s transitional status. The timing of cord clamping is after the establishment of regular spontaneous breathing evaluated on the respiratory function monitoring, together with heart rate above 100 bpm and oxygen saturation above 90% while using FiO₂ <40%. FiO₂, fractional inspired oxygen.