Physiological-based cord clamping (PBCC) in preterm infants. Experiences of resusc with intact cord?

[Stefan Johansson]

While preparing a lecture on the normal transition from intra- to extrauterine life, I also choosed to include a slide on cord-clamping, and the timing of it.

As the umbilical vein blood contributes significantly to the systemic cardiac output  (through shunting of umbilical vein blood through foramen ovale), there is a physiological reason to clamp/cut the cord once breathing is initiated.

While reading up on some details, I came across a feasibilty study on a resuscitation table intended for preterm infant: https://fn.bmj.com/content/early/2018/10/03/archdischild-2018-315483

Just recently - this research group also published that this approach of physiological-based cord clamping (PBCC) do increase cardiac output and cerebral oxygenation. Proxy outcomes, but still shows that the concept seems right: https://fn.bmj.com/content/103/6/F530

Just curious to hear: does anyone have experience from stabilization with intact cord (preterm or term)?

Update: also found this review by the same research group: https://fn.bmj.com/content/103/5/F493, also published in ADC FN.

[olamedmac]

As I believe you've noticed, we've just published a RCT on Intact Cord Resuscitation: https://doi.org/10.1186/s40748-019-0110-z

Unfortunately it was afflicted by a high protocol violation rate, but at least encourages further research.

[POJ]

In Linköping we have developed a structure on how to do this in deliveryroom on ELBW less than GW28. It works pretty well if you manage to deal well with the logistic. Receive on the foot-end of deliverybed between the legs of the mother, put the baby in a nest covered by plastic, using a mobile Neopuff with humidified warm gas, Starting with CPAP only awaiting the respond of heartrate and spontaneous breathing, ventilating only if bradycardia, delayed cordclamping. Incubator Close to the bed, connected to mobile CPAP/Ventilator. If intubation immediate Surfactant instillation. We have planned to enhance it into all Babies less than GW32 (33?). Working on a video on it.

Apart from a mobile neopuff, an incubator in Place and a mobile CPAP/ventilator you don´t need any extra equippment. But a well trained team and clear logistic is crucial  (protocol).

/Per