Journal articles: 'Intact Cord Resuscitation'

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Stamoulos, Suzanne, and Rachel Lavelle. "Neonatal resuscitation: ‘room side to motherside’." British Journal of Midwifery 27, no. 11 (November 2, 2019): 716–28. http://dx.doi.org/10.12968/bjom.2019.27.11.716.

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Delayed clamping of the neonatal umbilical cord is considered beneficial to the transition to extrauterine life in a term, uncomplicated birth. However, some neonates require resuscitation and the ability to perform this is a fundamental aspect of midwifery practice. The decision to clamp and cut the umbilical cord often precludes any resuscitative attempt, but the reasoning for this action is unclear. This article explores the purpose and place of leaving the umbilical cord intact during neonatal resuscitation. It considers the physiological basis for delaying cord clamping as well as the psychological benefits to baby, mother and family of leaving the cord intact until resuscitation is complete.

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Shim, Gyu Hong. "Review of Intact Cord Resuscitation." Perinatology 33, no. 1 (2022): 1. http://dx.doi.org/10.14734/pn.2022.33.1.1.

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Le Duc, Kévin, Sébastien Mur, Thameur Rakza, Mohamed Riadh Boukhris, Céline Rousset, Pascal Vaast, Nathalie Westlynk, Estelle Aubry, Dyuti Sharma, and Laurent Storme. "Efficacy of Intact Cord Resuscitation Compared to Immediate Cord Clamping on Cardiorespiratory Adaptation at Birth in Infants with Isolated Congenital Diaphragmatic Hernia (CHIC)." Children 8, no. 5 (April 26, 2021): 339. http://dx.doi.org/10.3390/children8050339.

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Resuscitation at birth of infants with Congenital Diaphragmatic Hernia (CDH) remains highly challenging because of severe failure of cardiorespiratory adaptation at birth. Usually, the umbilical cord is clamped immediately after birth. Delaying cord clamping while the resuscitation maneuvers are started may: (1) facilitate blood transfer from placenta to baby to augment circulatory blood volume; (2) avoid loss of venous return and decrease in left ventricle filling caused by immediate cord clamping; (3) prevent initial hypoxemia because of sustained uteroplacental gas exchange after birth when the cord is intact. The aim of this trial is to evaluate the efficacy of intact cord resuscitation compared to immediate cord clamping on cardiorespiratory adaptation at birth in infants with isolated CDH. The Congenital Hernia Intact Cord (CHIC) trial is a prospective multicenter open-label randomized controlled trial in two balanced parallel groups. Participants are randomized either immediate cord clamping (the cord will be clamped within the first 15 s after birth) or to intact cord resuscitation group (umbilical cord will be kept intact during the first part of the resuscitation). The primary end-point is the number of infants with APGAR score <4 at 1 min or <7 at 5 min. One hundred eighty participants are expected for this trial. To our knowledge, CHIC is the first study randomized controlled trial evaluating intact cord resuscitation on newborn infant with congenital diaphragmatic hernia. Better cardiorespiratory adaptation is expected when the resuscitation maneuvers are started while the cord is still connected to the placenta.

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Pratesi, Simone, Martina Ciarcià, Luca Boni, Stefano Ghirardello, Cristiana Germini, Stefania Troiani, Eleonora Tulli, et al. "Resuscitation With Placental Circulation Intact Compared With Cord Milking." JAMA Network Open 7, no. 12 (December 13, 2024): e2450476. https://doi.org/10.1001/jamanetworkopen.2024.50476.

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ImportanceAmong preterm newborns undergoing resuscitation, delayed cord clamping for 60 seconds is associated with reduced mortality compared with early clamping. However, the effects of longer durations of cord clamping with respiratory support are unknown.ObjectiveTo determine whether resuscitating preterm newborns while keeping the placental circulation intact and clamping the cord after a long delay would improve outcomes compared with umbilical cord milking.Design, Setting, and ParticipantsThis randomized clinical trial (PCI Trial) was conducted at 8 Italian neonatal intensive care units from April 2016 through February 2023 and enrolled preterm newborns born between 23 weeks 0 days and 29 weeks 6 days of gestation from singleton pregnancies.InterventionsEnrolled newborns were randomly allocated to receive at-birth resuscitation with intact placental circulation for 180 seconds or umbilical cord milking followed by an early cord clamping (within 20 seconds of life).Main Outcomes and MeasuresThe primary outcome was the composite end point of death, grade 3 to 4 intraventricular hemorrhage, and bronchopulmonary dysplasia at 36 weeks of postconception age. Prespecified secondary end points were the single components of the composite primary outcome. An intention-to-treat analysis was conducted.ResultsOf 212 mother-newborn dyads who were randomized, 209 (median [IQR] gestational age, 27 [26-28] weeks; median [IQR] birth weight, 900 [700-1070] g) were enrolled in the intention-to-treat population; 105 were randomized to the placental circulation intact group, and 104 were randomized to the cord milking group. The composite outcome of death, grade 3 to 4 intraventricular hemorrhage, or bronchopulmonary dysplasia occurred in 35 of 105 newborns (33%) in the placental circulation intact group vs 39 of 104 newborns (38%) in the cord milking group (odds ratio, 0.83; 95% CI, 0.47-1.47; P = .53).Conclusions and RelevanceIn a randomized clinical trial of preterm newborns at 23 to 29 weeks’ gestational age, intact placental resuscitation for 3 minutes did not lower the composite outcome of death, grade 3 to 4 intraventricular hemorrhage, or bronchopulmonary dysplasia compared with umbilical cord milking.Trial RegistrationClinicaltrials.gov Identifier: NCT02671305

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Koo, Jenny, and Anup Katheria. "Cardiopulmonary Resuscitation with an Intact Umbilical Cord." NeoReviews 23, no. 6 (June 1, 2022): e388-e399. http://dx.doi.org/10.1542/neo.23-6-e388.

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The body of literature supporting different umbilical management strategies has increased over the past decade as the role of cord management in neonatal transition is realized. Multiple international governing bodies endorse delayed cord clamping, and this practice is now widely accepted by obstetricians and neonatologists. Although term and preterm neonates benefit in some ways from delayed cord clamping, additional research on variations in this practice, including resuscitation with an intact cord, aim to find the optimal cord management practice that reduces mortality and major morbidities.

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Le Duc, Kévin, Estelle Aubry, Sébastien Mur, Capucine Besengez, Charles Garabedian, Julien De Jonckheere, Laurent Storme, and Dyuti Sharma. "Changes in Umbilico–Placental Circulation during Prolonged Intact Cord Resuscitation in a Lamb Model." Children 8, no. 5 (April 26, 2021): 337. http://dx.doi.org/10.3390/children8050337.

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Some previous studies reported a benefit to cardiopulmonary transition at birth when starting resuscitation maneuvers while the cord was still intact for a short period of time. However, the best timing for umbilical cord clamping in this condition is unknown. The aim of this study was to explore the duration of effective umbilico–placental circulation able to promote cardiorespiratory adaptation at birth during intact cord resuscitation. Umbilico–placental blood flow and vascular resistances were measured in an experimental neonatal lamb model. After a C-section delivery, the lambs were resuscitated ventilated for 1 h while the cord was intact. The maximum and mean umbilico–placental blood flow were respectively 230 ± 75 and 160 ± 12 mL·min−1 during the 1 h course of the experiment. However, umbilico–placental blood flow decreased and vascular resistance increased significantly 40 min after birth (p < 0.05). These results suggest that significant cardiorespiratory support can be provided by sustained placental circulation for at least 1 h during intact cord resuscitation.

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Mercer, Judith, Debra Erickson-Owens, Heike Rabe, Karen Jefferson, and Ola Andersson. "Making the Argument for Intact Cord Resuscitation: A Case Report and Discussion." Children 9, no. 4 (April 6, 2022): 517. http://dx.doi.org/10.3390/children9040517.

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We use a case of intact cord resuscitation to argue for the beneficial effects of an enhanced blood volume from placental transfusion for newborns needing resuscitation. We propose that intact cord resuscitation supports the process of physiologic neonatal transition, especially for many of those newborns appearing moribund. Transfer of the residual blood in the placenta provides the neonate with valuable access to otherwise lost blood volume while changing from placental respiration to breathing air. Our hypothesis is that the enhanced blood flow from placental transfusion initiates mechanical and chemical forces that directly, and indirectly through the vagus nerve, cause vasodilatation in the lung. Pulmonary vascular resistance is thereby reduced and facilitates the important increased entry of blood into the alveolar capillaries before breathing commences. In the presented case, enhanced perfusion to the brain by way of an intact cord likely led to regained consciousness, initiation of breathing, and return of tone and reflexes minutes after birth. Paramount to our hypothesis is the importance of keeping the umbilical cord circulation intact during the first several minutes of life to accommodate physiologic neonatal transition for all newborns and especially for those most compromised infants.

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Katheria, Anup C. "Neonatal Resuscitation with an Intact Cord: Current and Ongoing Trials." Children 6, no. 4 (April 22, 2019): 60. http://dx.doi.org/10.3390/children6040060.

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Premature and full-term infants are at high risk of morbidities such as intraventricular hemorrhage or hypoxic-ischemic encephalopathy. The sickest infants at birth are the most likely to die and or develop intraventricular hemorrhage. Delayed cord clamping has been shown to reduce these morbidities, but is currently not provided to those infants that need immediate resuscitation. This review will discuss recently published and ongoing or planned clinical trials involving neonatal resuscitation while the newborn is still attached to the umbilical cord. We will discuss the implications on neonatal management and delivery room care should this method become standard practice. We will review previous and ongoing trials that provided respiratory support compared to no support. Lastly, we will discuss the implications of implementing routine resuscitation support outside of a research setting.

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Ditai, James, Aisling Barry, Kathy Burgoine, Anthony K. Mbonye, Julius N. Wandabwa, Peter Watt, and Andrew D. Weeks. "The BabySaver: Design of a New Device for Neonatal Resuscitation at Birth with Intact Placental Circulation." Children 8, no. 6 (June 21, 2021): 526. http://dx.doi.org/10.3390/children8060526.

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The initial bedside care of premature babies with an intact cord has been shown to reduce mortality; there is evidence that resuscitation of term babies with an intact cord may also improve outcomes. This process has been facilitated by the development of bedside resuscitation surfaces. These new devices are unaffordable, however, in most of sub-Saharan Africa, where 42% of the world’s 2.4 million annual newborn deaths occur. This paper describes the rationale and design of BabySaver, an innovative low-cost mobile resuscitation unit, which was developed iteratively over five years in a collaboration between the Sanyu Africa Research Institute (SAfRI) in Uganda and the University of Liverpool in the UK. The final BabySaver design comprises two compartments; a tray to provide a firm resuscitation surface, and a base to store resuscitation equipment. The design was formed while considering contextual factors, using the views of individual women from the community served by the local hospitals, medical staff, and skilled birth attendants in both Uganda and the UK.

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Kuehne, Benjamin, Jan Trieschmann, Sarina Kim Butzer, Katrin Mehler, Ingo Gottschalk, Angela Kribs, and André Oberthuer. "Selective Extrauterine Placental Perfusion in Monochorionic Twins Is Feasible—A Case Series." Children 11, no. 10 (October 17, 2024): 1256. http://dx.doi.org/10.3390/children11101256.

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Background: Monochorionic (MC) twins are at risk for severe twin-to-twin transfusion syndrome (TTTS) or twin anemia-polycythemia sequence (TAPS). In the case of preterm delivery, cesarean section (CS) with immediate umbilical cord clamping (ICC) of both twins is usually performed. While the recipient is at risk for polycythemia and may benefit from ICC, this procedure may result in aggravation of anemia with increased morbidity in the anemic donor. The purpose of this study was to demonstrate that the novel approach of selective extrauterine placental perfusion (EPP) with delayed umbilical cord clamping (DCC) in the donor infant is feasible in neonatal resuscitation of MC twins and may prevent severe anemia in donor and polycythemia in the recipient. Methods: Preterm MC twins with antenatal suspected severe anemia of the donor as measured by Doppler ultrasound, born with birthweights < 1500 g by CS, were transferred to the neonatal resuscitation unit with placenta and intact umbilical cords. In the donor, the umbilical cord was left intact to provide DCC with parallel respiratory support (EPP approach), while the cord of the recipient was clamped immediately after identification. Results: Selective EPP was performed in three cases of MC twins with TAPS and acute peripartum TTTS. All donor twins had initial hemoglobin levels ≥ 13.0 g/dL, and none of them required red blood cell transfusion on the first day after birth. Conclusions: Selective EPP may be a feasible strategy for neonatal resuscitation of MC preterm twins with high stage TAPS and TTTS to prevent anemia-related morbidities and may improve infant outcome.

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Katheria, Anup, Debra Poeltler, Jayson Durham, Jane Steen, Wade Rich, Kathy Arnell, Mauricio Maldonado, Larry Cousins, and Neil Finer. "Neonatal Resuscitation with an Intact Cord: A Randomized Clinical Trial." Journal of Pediatrics 178 (November 2016): 75–80. http://dx.doi.org/10.1016/j.jpeds.2016.07.053.

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KC, Ashish, Shyam Sundar Budhathoki, Jeevan Thapa, Susan Niermeyer, Rejina Gurung, and Nalini Singhal. "Impact of stimulation among non-crying neonates with intact cord versus clamped cord on birth outcomes: observation study." BMJ Paediatrics Open 5, no. 1 (October 1, 2021): e001207. http://dx.doi.org/10.1136/bmjpo-2021-001207.

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BackgroundStimulation of non-crying neonates after birth can help transition to spontaneous breathing. In this study, we aim to assess the impact of intact versus clamped umbilical cord on spontaneous breathing after stimulation of non-crying neonates.MethodsThis is an observational study among non-crying neonates (n=3073) born in hospitals of Nepal. Non-crying neonates born vaginally at gestational age ≥34 weeks were observed for their response to stimulation with the cord intact or clamped. Obstetric characteristics of the neonates were analysed. Association of spontaneous breathing with cord management was assessed using logistic regression.ResultsAmong non-crying neonates, 2563 received stimulation. Of these, a higher proportion of the neonates were breathing in the group with cord intact as compared with the group cord clamped (81.1% vs 68.9%, p<0.0001). The use of bag-and-mask ventilation was lower among those who were stimulated with the cord intact than those who were stimulated with cord clamped (18.0% vs 32.4%, p<0.0001). The proportion of neonates with Apgar Score ≤3 at 1 min was lower with the cord intact than with cord clamped (7.6% vs 11.5%, p=0.001). In multivariate analysis, neonates with intact cord had 84% increased odds of spontaneous breathing (adjusted OR, 1.84; 95% CI: 1.48 to 2.29) compared with those with cord clamped.ConclusionsStimulation of non-crying neonates with intact cord was associated with more spontaneous breathing than among infants who were stimulated with cord clamped. Intact cord stimulation may help establish spontaneous breathing in apnoeic neonates, but residual confounding variables may be contributing to the findings. This study provides evidence for further controlled research to evaluate the effect of initial steps of resuscitation with cord intact.

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Hutchon, David, Simone Pratesi, and Anup Katheria. "How to Provide Motherside Neonatal Resuscitation with Intact Placental Circulation?" Children 8, no. 4 (April 8, 2021): 291. http://dx.doi.org/10.3390/children8040291.

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Nair, Jayasree, Lauren Davidson, Sylvia Gugino, Carmon Koenigsknecht, Justin Helman, Lori Nielsen, Deepika Sankaran, et al. "Sustained Inflation Reduces Pulmonary Blood Flow during Resuscitation with an Intact Cord." Children 8, no. 5 (April 29, 2021): 353. http://dx.doi.org/10.3390/children8050353.

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The optimal timing of cord clamping in asphyxia is not known. Our aims were to determine the effect of ventilation (sustained inflation–SI vs. positive pressure ventilation–V) with early (ECC) or delayed cord clamping (DCC) in asphyxiated near-term lambs. We hypothesized that SI with DCC improves gas exchange and hemodynamics in near-term lambs with asphyxial bradycardia. A total of 28 lambs were asphyxiated to a mean blood pressure of 22 mmHg. Lambs were randomized based on the timing of cord clamping (ECC—immediate, DCC—60 s) and mode of initial ventilation into five groups: ECC + V, ECC + SI, DCC, DCC + V and DCC + SI. The magnitude of placental transfusion was assessed using biotinylated RBC. Though an asphyxial bradycardia model, 2–3 lambs in each group were arrested. There was no difference in primary outcomes, the time to reach baseline carotid blood flow (CBF), HR ≥ 100 bpm or MBP ≥ 40 mmHg. SI reduced pulmonary (PBF) and umbilical venous (UV) blood flow without affecting CBF or umbilical arterial blood flow. A significant reduction in PBF with SI persisted for a few minutes after birth. In our model of perinatal asphyxia, an initial SI breath increased airway pressure, and reduced PBF and UV return with an intact cord. Further clinical studies evaluating the timing of cord clamping and ventilation strategy in asphyxiated infants are warranted.

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Mercer, Judith, Debra Erickson-Owens, Heike Rabe, and Ola Andersson. "Cardiac Asystole at Birth Re-Visited: Effects of Acute Hypovolemic Shock." Children 10, no. 2 (February 15, 2023): 383. http://dx.doi.org/10.3390/children10020383.

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Births involving shoulder dystocia or tight nuchal cords can deteriorate rapidly. The fetus may have had a reassuring tracing just before birth yet may be born without any heartbeat (asystole). Since the publication of our first article on cardiac asystole with two cases, five similar cases have been published. We suggest that these infants shift blood to the placenta due to the tight squeeze of the birth canal during the second stage which compresses the cord. The squeeze transfers blood to the placenta via the firm-walled arteries but prevents blood returning to the infant via the soft-walled umbilical vein. These infants may then be born severely hypovolemic resulting in asystole secondary to the loss of blood. Immediate cord clamping (ICC) prevents the newborn’s access to this blood after birth. Even if the infant is resuscitated, loss of this large amount of blood volume may initiate an inflammatory response that can enhance neuropathologic processes including seizures, hypoxic–ischemic encephalopathy (HIE), and death. We present the role of the autonomic nervous system in the development of asystole and suggest an alternative algorithm to address the need to provide these infants intact cord resuscitation. Leaving the cord intact (allowing for return of the umbilical cord circulation) for several minutes after birth may allow most of the sequestered blood to return to the infant. Umbilical cord milking may return enough of the blood volume to restart the heart but there are likely reparative functions that are carried out by the placenta during the continued neonatal–placental circulation allowed by an intact cord.

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Kumar, Manisha, Amit Gupta, Vijay Kumar, Anu Handa, Mayura Balliyan, Jyoti Meena, and Shubhasis Roychoudhary. "Management of CHAOS by intact cord resuscitation: case report and literature review." Journal of Maternal-Fetal & Neonatal Medicine 32, no. 24 (June 12, 2018): 4181–87. http://dx.doi.org/10.1080/14767058.2018.1481951.

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Rönnerhag, Maria, Li Thies-Lagergren, Ola Andersson, and Katarina Patriksson. "Parents as protectors: Experiences during intact cord resuscitation in the mother's bed." Journal of Neonatal Nursing 31, no. 3 (June 2025): 101635. https://doi.org/10.1016/j.jnn.2025.101635.

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Pidikiti, Lavanya, Anilkumar Sajjan, Raghavendra H. Gobbur, Siddu Charki, Vijayakumar Biradar, and M. M. Patil. "Malondialdehyde as a Prognosticating Marker for Staging of HIE - A Prospective Cohort Study." International Journal of Child Health and Nutrition 13, no. 1 (March 25, 2024): 25–30. http://dx.doi.org/10.6000/1929-4247.2024.13.01.3.

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Introduction: Prediction of outcomes of asphyxiated neonates is imperative. Timely intervention and effective resuscitation are beneficial for intact neurodevelopmental outcomes. In this study, we assessed the level of oxidative stress at birth in cord blood and correlated it with the Hypoxic Ischemic Encephalopathy (HIE) staging and outcomes. Methodology: This Prospective Cohort Study was conducted between January 2020 and June 2022. All neonates requiring resuscitation at birth were enrolled in a study group. The control group included neonates who did not require resuscitation. Cord blood was collected at birth, centrifuged, serum separated, and stored at -200C. Malondialdehyde (MDA) was read at 535nm on spectrometry. Results: 102 neonates were enrolled, among which 29 neonates were asphyxiated and 73 non-asphyxiated. The cord blood mean MDA level was significantly high in Severe HIE, with a p-value of <0.001. The serum MDA level in cord blood had a significant difference in asphyxiated neonates (8.59±1.99) and normal neonates (3.18±1.04) (P<0.001). There is a significant difference in MDA levels in cord blood; the mean MDA level was significantly higher in HIE III (10.93±2.50), compared to HIE II (9.98±2.34) and HIE I(7.72±1.09) with a p-value of <0.001. Deceased neonates had higher MDA levels than those neonates who survived. Conclusion: Neonates with high oxidative stress at birth require advanced resuscitation. MDA levels above 7.64 mm/L have 100% sensitivity and 81.4% specificity with respect to mortality in asphyxiated neonates. Hence, cord blood MDA can be a prognostic marker of oxidative stress to predict the outcomes in asphyxiated neonates.

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Thomas, M., C. Yoxall, A. Weeks, and L. Duley. "G106 Providing Neonatal resuscitation at the maternal bedside with an intact umbilical cord." Archives of Disease in Childhood 99, Suppl 1 (April 1, 2014): A45. http://dx.doi.org/10.1136/archdischild-2014-306237.106.

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Joshi, Neha S., Kimber Padua, Jules Sherman, Douglas Schwandt, Lillian Sie, Arun Gupta, Louis P. Halamek, and Henry C. Lee. "A Feasibility Study of a Novel Delayed Cord Clamping Cart." Children 8, no. 5 (April 29, 2021): 357. http://dx.doi.org/10.3390/children8050357.

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Delaying umbilical cord clamping (DCC) for 1 min or longer following a neonate’s birth has now been recommended for preterm and term newborns by multiple professional organizations. DCC has been shown to decrease rates of iron deficiency anemia, intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), and blood transfusion. Despite these benefits, clinicians typically cut the umbilical cord without delay in neonates requiring resuscitation and move them to a radiant warmer for further care; this effectively prevents these patients from receiving any benefits from DCC. This study evaluated the feasibility of a delayed cord clamping cart (DCCC) in low-risk neonates born via Cesarean section (CS). The DCCC is a small, sterile cart designed to facilitate neonatal resuscitation while the umbilical cord remains intact. The cart is cantilevered over the operating room (OR) table during a CS, allowing the patient to be placed onto it immediately after birth. For this study, a sample of 20 low-risk CS cases were chosen from the non-emergency Labor and Delivery surgical case list. The DCCC was utilized for 1 min of DCC in all neonates. The data collected included direct observation by research team members, recorded debriefings and surveys of clinicians as well as surveys of patients. Forty-four care team members participated in written surveys; of these, 16 (36%) were very satisfied, 12 (27%) satisfied, 13 (30%) neutral, and 3 (7%) were somewhat dissatisfied with use of the DCCC in the OR. Feedback was collected from all 20 patients, with 18 (90%) reporting that they felt safe with the device in use. This study provides support that utilizing a DCCC can facilitate DCC with an intact umbilical cord.

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Choudhary, Sushil, Arun Singh, Anurag Pandey, Neeraj Gupta, Anil Kumar, and Swasthi Kabisatpathy. "Does early heart rate detection and continuous monitoring have an impact on neonatal resuscitation in newborns with intact cord? – An observational study." Journal of Family Medicine and Primary Care 13, no. 12 (December 2024): 5655–61. https://doi.org/10.4103/jfmpc.jfmpc_752_24.

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ABSTRACT Context: Heart rate (HR) is the most vital parameter to assess hemodynamic transition at birth. ECG is considered a gold standard for HR assessment. New devices with dry electrodes are easy to apply on a wet newborn. However, the utilization of newer technology that captures fast and reliable HR, and its impact on neonate resuscitation are yet to be explored, especially in newborns with intact cords. Aims: to detect HR early by dry electrode devices and its impact on neonatal resuscitation. Settings and Design: This is an observational study conducted at a tertiary care hospital in India. Methods and Material: A portable pulse oximeter, conventional ECG with modified 3 electrodes, and dry electrodes ECG (Neo Beat) were applied to capture HR ECG and Sp02. First reliable HR and outcomes of neonates were compared. Statistical Analysis Used: Median (IQR) was calculated for quantitative data. These were conducted using an updated version of IBM SPSS Statistics 22 software. Results: Out of 329 newborns, 24 newborns had their first documented HR of less than 100 bpm, out of which 14 (58%) initiated respiration with initial steps and the rest 10 required resuscitation (42%) in the form of positive pressure ventilation. Among newborns with a first HR of more than 100 bpm, 8 newborns (2.6%) required resuscitation. The median duration to capture the first reliable HR using dry electrodes was 15 sec (IQR 12.7–20 sec), which was much faster than the time required by conventional ECG (37 sec) and pulse oximetry (80 sec). Conclusions: First reliable HR can effectively predict the need for neonatal resuscitation. Dry electrode ECG can effectively capture continuous and reliable HR. HR trends can further assist in predicting the need for neonatal resuscitation and the efficacy of neonatal resuscitation.

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Pratesi, Simone, Iuri Corsini, Caterina Coviello, Silvia Perugi, and Carlo Dani. "Resuscitation with Intact Placental Circulation in a Preterm Infant with Hydrops Fetalis." American Journal of Perinatology Reports 07, no. 01 (January 2017): e28-e30. http://dx.doi.org/10.1055/s-0037-1598200.

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A preterm infant with prenatal diagnosis of hydrops fetalis was spontaneously delivered at 30 weeks of gestational age in a tertiary level hospital. Prenatal echography pointed out severe bilateral pleural effusions and diffused subcutaneous edema. A neonatologist team, alerted at the expulsion stage of labor, assisted the neonate immediately after birth and bilateral hydrothorax was drained with intact placental circulation to avoid a nonrespiratory period and its possible detrimental hemodynamic effects. The newborn was well stabilized in the delivery room before cutting the umbilical cord and starting mechanical ventilation. Unfortunately, our patient died due to refractory respiratory failure on the fourth day of life. However, the intact placental circulation procedure was performed without adverse effects to the infant and might represent a promising option in addition to other resuscitation procedures for the management of this type of patient.

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Chandrasekharan, Praveen, Sylvia Gugino, Justin Helman, Carmon Koenigsknecht, Lori Nielsen, Nicole Bradley, Jayasree Nair, et al. "Resuscitation with an Intact Cord Enhances Pulmonary Vasodilation and Ventilation with Reduction in Systemic Oxygen Exposure and Oxygen Load in an Asphyxiated Preterm Ovine Model." Children 8, no. 4 (April 17, 2021): 307. http://dx.doi.org/10.3390/children8040307.

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(1) Background: Optimal initial oxygen (O2) concentration in preterm neonates is controversial. Our objectives were to compare the effect of delayed cord clamping with ventilation (DCCV) to early cord clamping followed by ventilation (ECCV) on O2 exposure, gas exchange, and hemodynamics in an asphyxiated preterm ovine model. (2) Methods: Asphyxiated preterm lambs (127–128 d) with heart rate <90 bpm were randomly assigned to DCCV or ECCV. In DCCV, positive pressure ventilation (PPV) was initiated with 30–60% O2 and titrated based on preductal saturations (SpO2) with an intact cord for 5 min, followed by clamping. In ECCV, the cord was clamped, and PPV was initiated. (3) Results: Fifteen asphyxiated preterm lambs were randomized to DCCV (N = 7) or ECCV (N = 8). The inspired O2 (40 ± 20% vs. 60 ± 20%, p < 0.05) and oxygen load (520 (IQR 414–530) vs. 775 (IQR 623–868), p-0.03) in the DCCV group were significantly lower than ECCV. Arterial oxygenation and carbon dioxide (PaCO2) levels were significantly lower and peak pulmonary blood flow was higher with DCCV. (4) Conclusion: In asphyxiated preterm lambs, resuscitation with an intact cord decreased O2 exposure load improved ventilation with an increase in peak pulmonary blood flow in the first 5 min.

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Lefebvre, Caroline, Thameur Rakza, Nathalie Weslinck, Pascal Vaast, Véronique Houfflin-debarge, Sébastien Mur, and Laurent Storme. "Feasibility and safety of intact cord resuscitation in newborn infants with congenital diaphragmatic hernia (CDH)." Resuscitation 120 (November 2017): 20–25. http://dx.doi.org/10.1016/j.resuscitation.2017.08.233.

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Fulton, Colleen, Kathrin Stoll, and Dana Thordarson. "Bedside resuscitation of newborns with an intact umbilical cord: Experiences of midwives from British Columbia." Midwifery 34 (March 2016): 42–46. http://dx.doi.org/10.1016/j.midw.2016.01.006.

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Kuehne, Benjamin, Berthold Grüttner, Martin Hellmich, Barbara Hero, Angela Kribs, and André Oberthuer. "Extrauterine Placental Perfusion and Oxygenation in Infants With Very Low Birth Weight." JAMA Network Open 6, no. 11 (November 3, 2023): e2340597. http://dx.doi.org/10.1001/jamanetworkopen.2023.40597.

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ImportanceAn extrauterine placental perfusion (EPP) approach for physiological-based cord clamping (PBCC) may support infants with very low birth weight (VLBW) during transition without delaying measures of support.ObjectiveTo test whether EPP in resuscitation of infants with VLBW results in higher hematocrit levels, better oxygenation, or improved infant outcomes compared with delayed cord clamping (DCC).Design, Setting, and ParticipantsThis nonblinded, single-center randomized clinical trial was conducted at a tertiary care neonatal intensive care unit. Infants with a gestational age greater than 23 weeks and birth weight less than 1500 g born by cesarean delivery between May 2019 and June 2021 were included. Data were analyzed from October through December 2021.InterventionPrior to cesarean delivery, participants were allocated to receive EPP or DCC. In the EPP group, infant and placenta, connected by an intact umbilical cord, were detached from the uterus and transferred to the resuscitation unit. Respiratory support was initiated while holding the placenta over the infant. The umbilical cord was clamped when infants showed regular spontaneous breathing, stable heart rates greater than 100 beats/min, and adequate oxygen saturations. In the DCC group, cords were clamped 30 to 60 seconds after birth before infants were transferred to the resuscitation unit, where respiratory support was started.Main Outcomes and MeasureThe primary outcome was the mean hematocrit level in the first 24 hours after birth. Secondary prespecified outcome parameters comprised oxygenation during transition and short-term neonatal outcome.ResultsAmong 60 infants randomized and included, 1 infant was excluded after randomization; there were 29 infants in the EPP group (mean [SD] gestational age, 27 weeks 6 days [15.0 days]; 14 females [48.3%]) and 30 infants in the DCC group (mean [SD] gestational age, 28 weeks 1 day [17.1 days]; 17 females [56.7%]). The mean (SD) birth weight was 982.8 (276.6) g and 970.2 (323.0) g in the EPP and DCC group, respectively. Intention-to-treat analysis revealed no significant difference in mean hematocrit level (mean difference [MD], 2.1 percentage points; [95% CI, −2.2 to 6.4 percentage points]). During transition, infants in the EPP group had significantly higher peripheral oxygen saturation as measured by pulse oximetry (adjusted MD at 5 minutes, 15.3 percentage points [95% CI, 2.0 to 28.6 percentage points]) and regional cerebral oxygen saturation (adjusted MD at 5 minutes, 11.3 percentage points [95% CI, 2.0 to 20.6 percentage points]). Neonatal outcome parameters were similar in the 2 groups.Conclusions and RelevanceThis study found that EPP resulted in similar hematocrit levels as DCC, with improved cerebral and peripheral oxygenation during transition. These findings suggest that EPP may be an alternative procedure for PBCC in infants with VLBW.Trial RegistrationClinicalTrials.gov Identifier: NCT03916159

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Katheria, Anup C. "Correction: Anup C. Katheria. Neonatal Resuscitation with an Intact Cord: Current and Ongoing Trials. Children 2019, 6, 60." Children 6, no. 5 (May 21, 2019): 71. http://dx.doi.org/10.3390/children6050071.

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Deepak Francis, Trinity, N. Gupta, and A. K. Singh. "PP239 Topic: AS24–Resuscitation, Stabilization & Transport: Rapid Response Teams/ECMO Transport/Air Transport/Telemedicine/Other: RESUSCITATION OF AT-RISK TERM AND LATE PRE-TERM NEONATES WITH INTACT CORD VS EARLY CORD CLAMPING: A RANDOMIZED CONTROLLED TRIAL (RANI)." Pediatric Critical Care Medicine 25, no. 11S (November 2024): e80-e80. http://dx.doi.org/10.1097/01.pcc.0001085356.55688.ac.

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Hoyle, Emily Suzanne, Sunaya Hirani, Sally Ogden, Jenna Deeming, and Charles William Yoxall. "Quality improvement programme to increase the rate of deferred cord clamping at preterm birth using the Lifestart trolley." Archives of Disease in Childhood - Fetal and Neonatal Edition 105, no. 6 (April 29, 2020): 652–55. http://dx.doi.org/10.1136/archdischild-2019-318636.

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AimTo increase the documented use of the Lifestart trolley to allow premature infants’ (<32 weeks’ gestation) resuscitation and stabilisation with an intact umbilical cord at delivery.DesignA 13-month quality improvement programme from April 2018 to April 2019 was undertaken using Plan, Do, Study and Act (PDSA) cycles. Data were reviewed from 113 consecutive preterm (<32 weeks) deliveries to identify whether Lifestart was used and whether 2 min deferred cord clamping (DCC) occurred in eligible infants as per hospital policy. Episodes of non-compliance were analysed, causes established and interventions implemented to reduce similar future non-compliance. Data collected were presented graphically and included in alternate monthly newsletters to staff, which also included lessons learnt from the reviews of non-compliance.ResultsDocumented use of the Lifestart rose from 10% at the start of the project to 79% in the final month. Not all babies are eligible for DCC. Within this project, 40 (35%) of preterm infants were not eligible to receive DCC. Of those that were eligible, the rate of DCC increased from 17% in the first 3 months to 92% in the last 3 months of the project (p<0.0001).Implications and relevanceBy undertaking regular PDSA cycles and improving education surrounding importance of DCC, we have noted a significant improvement in the use of Lifestart, which in turn facilitates DCC.The learning from this project has been used to create an instructional video to help maintain the improved compliance rates.

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Duley, Lelia, Jon Dorling, Susan Ayers, Sandy Oliver, Charles William Yoxall, Andrew Weeks, Chris Megone, et al. "Improving quality of care and outcome at very preterm birth: the Preterm Birth research programme, including the Cord pilot RCT." Programme Grants for Applied Research 7, no. 8 (September 2019): 1–280. http://dx.doi.org/10.3310/pgfar07080.

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Background Being born very premature (i.e. before 32 weeks’ gestation) has an impact on survival and quality of life. Improving care at birth may improve outcomes and parents’ experiences. Objectives To improve the quality of care and outcomes following very preterm birth. Design We used mixed methods, including a James Lind Alliance prioritisation, a systematic review, a framework synthesis, a comparative review, qualitative studies, development of a questionnaire tool and a medical device (a neonatal resuscitation trolley), a survey of practice, a randomised trial and a protocol for a prospective meta-analysis using individual participant data. Setting For the prioritisation, this included people affected by preterm birth and health-care practitioners in the UK relevant to preterm birth. The qualitative work on preterm birth and the development of the questionnaire involved parents of infants born at three maternity hospitals in southern England. The medical device was developed at Liverpool Women’s Hospital. The survey of practice involved UK neonatal units. The randomised trial was conducted at eight UK tertiary maternity hospitals. Participants For prioritisation, 26 organisations and 386 individuals; for the interviews and questionnaire tool, 32 mothers and seven fathers who had a baby born before 32 weeks’ gestation for interviews evaluating the trolley, 30 people who had experienced it being used at the birth of their baby (19 mothers, 10 partners and 1 grandmother) and 20 clinicians who were present when it was being used; for the trial, 261 women expected to have a live birth before 32 weeks’ gestation, and their 276 babies. Interventions Providing neonatal care at very preterm birth beside the mother, and with the umbilical cord intact; timing of cord clamping at very preterm birth. Main outcome measures Research priorities for preterm birth; feasibility and acceptability of the trolley; feasibility of a randomised trial, death and intraventricular haemorrhage. Review methods Systematic review of Cochrane reviews (umbrella review); framework synthesis of ethics aspects of consent, with conceptual framework to inform selection criteria for empirical and analytical studies. The comparative review included studies using a questionnaire to assess satisfaction with care during childbirth, and provided psychometric information. Results Our prioritisation identified 104 research topics for preterm birth, with the top 30 ranked. An ethnographic analysis of decision-making during this process suggested ways that it might be improved. Qualitative interviews with parents about their experiences of very preterm birth identified two differences with term births: the importance of the staff appearing calm and of staff taking control. Following a comparative review, this led to the development of a questionnaire to assess parents’ views of care during very preterm birth. A systematic overview summarised evidence for delivery room neonatal care and revealed significant evidence gaps. The framework synthesis explored ethics issues in consent for trials involving sick or preterm infants, concluding that no existing process is ideal and identifying three important gaps. This led to the development of a two-stage consent pathway (oral assent followed by written consent), subsequently evaluated in our randomised trial. Our survey of practice for care at the time of birth showed variation in approaches to cord clamping, and that no hospitals were providing neonatal care with the cord intact. We showed that neonatal care could be provided beside the mother using either the mobile neonatal resuscitation trolley we developed or existing equipment. Qualitative interviews suggested that neonatal care beside the mother is valued by parents and acceptable to clinicians. Our pilot randomised trial compared cord clamping after 2 minutes and initial neonatal care, if needed, with the cord intact, with clamping within 20 seconds and initial neonatal care after clamping. This study demonstrated feasibility of a large UK randomised trial. Of 135 infants allocated to cord clamping ≥ 2 minutes, 7 (5.2%) died and, of 135 allocated to cord clamping ≤ 20 seconds, 15 (11.1%) died (risk difference –5.9%, 95% confidence interval –12.4% to 0.6%). Of live births, 43 out of 134 (32%) allocated to cord clamping ≥ 2 minutes had intraventricular haemorrhage compared with 47 out of 132 (36%) allocated to cord clamping ≤ 20 seconds (risk difference –3.5%, 95% CI –14.9% to 7.8%). Limitations Small sample for the qualitative interviews about preterm birth, single-centre evaluation of neonatal care beside the mother, and a pilot trial. Conclusions Our programme of research has improved understanding of parent experiences of very preterm birth, and informed clinical guidelines and the research agenda. Our two-stage consent pathway is recommended for intrapartum clinical research trials. Our pilot trial will contribute to the individual participant data meta-analysis, results of which will guide design of future trials. Future work Research in preterm birth should take account of the top priorities. Further evaluation of neonatal care beside the mother is merited, and future trial of alternative policies for management of cord clamping should take account of the meta-analysis. Study registration This study is registered as PROSPERO CRD42012003038 and CRD42013004405. In addition, Current Controlled Trials ISRCTN21456601. Funding This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 7, No. 8. See the NIHR Journals Library website for further project information.

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Wu, Xianren, Tomas Drabek, Samuel A. Tisherman, Jeremy Henchir, S. William Stezoski, Sherman Culver, Jason Stezoski, Edwin K. Jackson, Robert Garman, and Patrick M. Kochanek. "Emergency Preservation and Resuscitation with Profound Hypothermia, Oxygen, and Glucose Allows Reliable Neurological Recovery after 3 h of Cardiac Arrest from Rapid Exsanguination in Dogs." Journal of Cerebral Blood Flow & Metabolism 28, no. 2 (July 11, 2007): 302–11. http://dx.doi.org/10.1038/sj.jcbfm.9600524.

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We have used a rapid induction of profound hypothermia (> 10°C) with delayed resuscitation using cardiopulmonary bypass (CPB) as a novel approach for resuscitation from exsanguination cardiac arrest (ExCA). We have defined this approach as emergency preservation and resuscitation (EPR). We observed that 2 h but not 3 h of preservation could be achieved with favorable outcome using ice-cold normal saline flush to induce profound hypothermia. We tested the hypothesis that adding energy substrates to saline during induction of EPR would allow intact recovery after 3 h CA. Dogs underwent rapid ExCA. Two minutes after CA, EPR was induced with arterial ice-cold flush. Four treatments ( n = 6/group) were defined by a flush solution with or without 2.5% glucose (G + or G–) and with either oxygen or nitrogen (O + or O–) rapidly targeting tympanic temperature of 8°C. At 3 h after CA onset, delayed resuscitation was initiated with CPB, followed by intensive care to 72 h. At 72 h, all dogs in the O + G + group regained consciousness, and the group had better neurological deficit scores and overall performance categories than the O—groups (both P < 0.05). In the O + G—group, four of the six dogs regained consciousness. All but one dog in the O—groups remained comatose. Brain histopathology in the O—G + was worse than the other three groups ( P < 0.05). We conclude that EPR induced with a flush solution containing oxygen and glucose allowed satisfactory recovery of neurological function after a 3 h of CA, suggesting benefit from substrate delivery during induction or maintenance of a profound hypothermic CA.

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Takeda, Yoshimasa, Hiroshi Hashimoto, Koji Fumoto, Tetsuya Danura, Hiromichi Naito, Naoki Morimoto, Hiroshi Katayama, et al. "Effects of Pharyngeal Cooling on Brain Temperature in Primates and Humans." Anesthesiology 117, no. 1 (July 1, 2012): 117–25. http://dx.doi.org/10.1097/aln.0b013e3182580536.

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Background Pharyngeal cooling decreases brain temperature by cooling carotid arteries. This study was designed to evaluate the principle of pharyngeal cooling in monkeys and humans. Methods Monkeys (n = 10) were resuscitated following 12 min of cardiac arrest. Pharyngeal cooling (n = 5), in which cold saline (5°C) was perfused into the cuff at the rate of 500 ml/min, was initiated simultaneously with the onset of resuscitation for 30 min. Patients (n = 3) who were in an intensive care unit were subjected to 30 min of pharyngeal cooling under propofol anesthesia. Results In the animal study, core brain temperature was significantly decreased compared with that in the control group by 1.9°C (SD = 0.8, P < 0.001) and 3.1°C (SD = 1.0, P < 0.001) at 10 min and 30 min after the onset of cooling, respectively. The cooling effect was more evident in an animal with low postresuscitation blood pressure. Total dose of epinephrine, number of direct current shocks, and recovery of blood pressure were not different between the two groups. The pharyngeal epithelium was microscopically intact on day 5. In the clinical study, insertion of the cuff and start of perfusion did not affect heart rate or blood pressure. Tympanic temperature was decreased by 0.6 ± 0.1°C/30 min without affecting bladder temperature. The pharynx was macroscopically intact for 3 days. Conclusions Pharyngeal cooling rapidly and selectively decreased brain temperature in primates and tympanic temperature in humans and did not have adverse effects on return of spontaneous circulation, even when initiated during cardiac arrest in primates.

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Patriksson, Katarina, Ola Andersson, Li Thies-Lagergren, and Maria Rönnerhag. "Neonatal healthcare professionals’ experiences of intact cord resuscitation in the mother´s bed- an interview study." BMC Pregnancy and Childbirth 24, no. 1 (May 15, 2024). http://dx.doi.org/10.1186/s12884-024-06558-0.

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Abstract Background Intact cord resuscitation in the first three minutes of life improves oxygenation and Apgar scores. The practise of intact cord resuscitation implies the umbilical cord still being connected to the placenta for at least one minute while providing temperature control and equipment for resuscitation. Healthcare professionals described practical challenges in providing intact cord resuscitation. This study aimed to explore neonatal healthcare professionals’ experiences of providing intact cord resuscitation in the mother’s bed. Method An interview study with an inductive, interpretative approach was chosen and analysed according to reflexive thematic analysis by Braun & Clarke. An open interview guide was used and 20 individual interviews with neonatal healthcare professionals were performed. The study was conducted at five level I-III neonatal care units. In Sweden, resuscitation is performed either in or outside the labour room. Results The results contributed insight into the participants’ experiences of prerequisites for providing neonatal care in intact cord resuscitation. The sense of the mother’s vulnerability was noticeable, as the participants reported reducing the risk of exposure to protect and preserve the mother’s integrity. The practical challenges in the environment involved working in a limited space. The desire for multi-professional team training comprised education and training as well as debriefing to manage intact cord resuscitation. Conclusion The result of the present study highlights the fact that neonatal healthcare professionals’ experiences of providing ICR in the mother’s bed were positive and had significant benefits for the neonate, namely zero separation between the neonate and parents and better physical recovery for the neonate. However, the fact that ICR in the mother’s bed can be challenging in several ways, such as emotionally, managing environmental circumstances and ensuring effective team collaboration. Therefore, it is of the utmost importance that healthcare professionals are given the opportunity to reflect and train together as a team. Future recommendations are to summarize evidence-based knowledge to design guidelines for ICR situation.

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Major, Gréta Sz, Vivien Unger, Rita Nagy, Márk Hernádfői, Dániel S. Veres, Ádám Zolcsák, Miklós Szabó, et al. "Umbilical cord management in newborn resuscitation: a systematic review and meta-analysis." Pediatric Research, September 2, 2024. http://dx.doi.org/10.1038/s41390-024-03496-7.

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Abstract Background Evidence supporting the benefits of delayed cord clamping is increasing; however, there is no clear recommendation on cord management during newborn resuscitation. This study aimed to investigate the effects of resuscitation initiated with an intact umbilical cord, hypothesizing it is a safe stabilization procedure that improves neonatal outcomes. Methods Systematic search was conducted in MEDLINE, Embase, CENTRAL, and Web of Science from inception to March 1, 2024. Eligible articles compared neonatal outcomes in newborns receiving initial stabilization steps before and after cord clamping. Results Twelve studies met our inclusion criteria, with six RCTs included in the quantitative analysis. No statistically significant differences were found in delivery room parameters, in-hospital mortality, or neonatal outcomes between the examined groups. However, intact cord resuscitation group showed higher SpO2 at 5 min after birth compared to cord clamping prior to resuscitation group (MD 6.67%, 95% CI [−1.16%, 14.50%]). There were no significant differences in early complications of prematurity (NEC ≥ stage 2: RR 2.05, 95% CI [0.34, 12.30], IVH: RR 1.25, 95% CI [0.77, 2.00]). Conclusion Intact cord management during resuscitation appears to be a safe intervention; its effect on early complications of prematurity remains unclear. Further high-quality RCTs with larger patient numbers are urgently needed. Impact Initiating resuscitation with an intact umbilical cord appears to be a safe intervention for newborns. No statistically significant differences were found in delivery room parameters, in-hospital mortality, and neonatal outcomes between the examined groups. The utilization of specialized resuscitation trolleys appears to be promising to reduce the risk of intraventricular hemorrhage in preterm infants. Further high-quality RCTs with larger sample sizes are urgently needed to refine recommendations.

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Ekelöf, Katarina, Elisabeth Sæther, Anna Santesson, Maria Wilander, Katarina Patriksson, Susanne Hesselman, Li Thies-Lagergren, Heike Rabe, and Ola Andersson. "A hybrid type I, multi-center randomized controlled trial to study the implementation of a method for Sustained cord circulation And VEntilation (the SAVE-method) of late preterm and term neonates: a study protocol." BMC Pregnancy and Childbirth 22, no. 1 (July 26, 2022). http://dx.doi.org/10.1186/s12884-022-04915-5.

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Abstract Background An intact umbilical cord allows the physiological transfusion of blood from the placenta to the neonate, which reduces infant iron deficiency and is associated with improved development during early childhood. The implementation of delayed cord clamping practice varies depending on mode of delivery, as well as gestational age and neonatal compromise. Emerging evidence shows that infants requiring resuscitation would benefit if respiratory support were provided with the umbilical cord intact. Common barriers to providing intact cord resuscitation is the availability of neonatal resuscitation equipment close to the mother, organizational readiness for change as well as attitudes and beliefs about placental transfusion within the multidisciplinary team. Hence, clinical evaluations of cord clamping practice should include implementation outcomes in order to develop strategies for optimal cord management practice. Methods The Sustained cord circulation And Ventilation (SAVE) study is a hybrid type I randomized controlled study combining the evaluation of clinical outcomes with implementation and health service outcomes. In phase I of the study, a method for providing in-bed intact cord resuscitation was developed, in phase II of the study the intervention was adapted to be used in multiple settings. In phase III of the study, a full-scale multicenter study will be initiated with concurrent evaluation of clinical, implementation and health service outcomes. Clinical data on neonatal outcomes will be recorded at the labor and neonatal units. Implementation outcomes will be collected from electronic surveys sent to parents as well as staff and managers within the birth and neonatal units. Descriptive and comparative statistics and regression modelling will be used for analysis. Quantitative data will be supplemented by qualitative methods using a thematic analysis with an inductive approach. Discussion The SAVE study enables the safe development and evaluation of a method for intact cord resuscitation in a multicenter trial. The study identifies barriers and facilitators for intact cord resuscitation. The knowledge provided from the study will be of benefit for the development of cord clamping practice in different challenging clinical settings and provide evidence for development of clinical guidelines regarding optimal cord clamping. Trial registration Clinicaltrials.gov, NCT04070560. Registered 28 August 2019.

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Mohamied, Fatimah. "Hot Topic: Intact cord resuscitation for term infants under midwifery care." Student Midwife 2, no. 1 (January 1, 2019). http://dx.doi.org/10.55975/nomu9858.

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Immediate cord clamping (ICC), followed by immediate disconnection of an infant from its mother and subsequent relocation to a separate resuscitation platform, is the current mode of practice when respiratory support is required at birth (Hutchon and Bettles 2016). This practice is supported by a World Health Organization (WHO) (2012) guideline on basic newborn resuscitation. However, this recommendation is based upon weak evidence that was developed for hastened uterotonic drug administration, to prevent the incidence of postpartum haemorrhage (PPH) (Hutchon 2015). However, WHO (2012) continues to suggest ventilation before cord occlusion if practitioners experienced in intact cord resuscitation (ICR) are present. While midwives conduct neonatal resuscitation, they also facilitate delayed cord clamping (DCC) for at least 60 seconds, which is recommended by National Institute for Health and Care Excellence (NICE) (2014) for many documented benefits. However, compromised neonates are excluded from this (NICE 2014), and may be the population most in need of DCC during resuscitation (Hutchon 2015), as demonstrated by the stabilising haemodynamic effect of initiating ventilation before cord clamping in neonatal lambs (Bhatt et al 2013). This may provide a protective mechanism against intraventricular haemorrhage and cerebral injury, which are known risks in neonates requiring resuscitation. The aim of this work is to investigate and review ICR for term infants, in order to support ICR adoption into midwifery practice, through literature review. Studies included were publications within the past five years: quantitative studies, qualitative studies and reviews involving term or late-preterm human infants.

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Rabe, Heike, Judith Mercer, and Debra Erickson-Owens. "What does the evidence tell us? Revisiting optimal cord management at the time of birth." European Journal of Pediatrics, February 2, 2022. http://dx.doi.org/10.1007/s00431-022-04395-x.

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AbstractA newborn who receives a placental transfusion at birth from delayed cord clamping (DCC) obtains about 30% more blood volume than those with immediate cord clamping (ICC). Benefits for term neonates include higher hemoglobin levels, less iron deficiency in infancy, improved myelination out to 12 months, and better motor and social development at 4 years of age especially in boys. For preterm infants, benefits include less intraventricular hemorrhage, fewer gastrointestinal issues, lower transfusion requirements, and less mortality in the neonatal intensive care unit by 30%. Ventilation before clamping the umbilical cord can reduce large swings in cardiovascular function and help to stabilize the neonate. Hypovolemia, often associated with nuchal cord or shoulder dystocia, may lead to an inflammatory cascade and subsequent ischemic injury. A sudden unexpected neonatal asystole at birth may occur from severe hypovolemia. The restoration of blood volume is an important action to protect the hearts and brains of neonates. Currently, protocols for resuscitation call for ICC. However, receiving an adequate blood volume via placental transfusion may be protective for distressed neonates as it prevents hypovolemia and supports optimal perfusion to all organs. Bringing the resuscitation to the mother’s bedside is a novel concept and supports an intact umbilical cord. When one cannot wait, cord milking several times can be done quickly within the resuscitation guidelines. Cord blood gases can be collected with optimal cord management. Conclusion: Adopting a policy for resuscitation with an intact cord in a hospital setting takes a coordinated effort and requires teamwork by obstetrics, pediatrics, midwifery, and nursing. What is Known:• Placental transfusion through optimal cord management benefits morbidity and mortality of newborn infants.• The World Health Organisation has recommended placental transfusion in their guidance. What is New:• Improved understanding of transitioning to extrauterine life has been described.• Resuscitation of newborn infants whilst the umbilical cord remains intact could improve the postpartum adaptation.

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Edwards, Hannah, Rebecca Dorner, and Anup Katheria. "Optimizing Transition: Providing Oxygen during Intact Cord Resuscitation." Seminars in Perinatology, June 2023, 151787. http://dx.doi.org/10.1016/j.semperi.2023.151787.

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Raina, Jaspreet Singh, Deepak Chawla, Suksham Jain, and Supreet Khurana. "Development and testing of an intact cord resuscitation trolley." BMJ Innovations, June 23, 2022, bmjinnov—2022–000950. http://dx.doi.org/10.1136/bmjinnov-2022-000950.

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ObjectiveTo develop a mobile resuscitation platform—intact cord resuscitation (ICR) trolley and to assess the safety, feasibility and acceptability of its use during delayed cord clamping (DCC).Study designBench-side product development and single-arm experimental study.Participants and methodsWe first developed a theoretical framework of the specifications required for the platform which can provide resuscitation close to the delivery/operating table. The theoretical framework was then translated into a working model in a series of iterations. After testing and training of healthcare workers in a simulated environment, the trolley was tested to perform DCC in neonates who were born at ≥34 weeks of gestation and were breathing spontaneously at birth.Outcomes measuredPrimary outcome was the feasibility of DCC using the ICR trolley defined as the proportion of babies successfully completing 180 s of DCC on the trolley. Secondary outcomes included the proportion of babies with 1 min heart rate (HR) and oxygen saturation (SpO2) recorded, neonatal and maternal safety outcomes, and acceptability among care providers.ResultsAmong 50 neonates (gestation: 36.9±1.9 weeks and birth weight: 2544±649 g) enrolled in the study, DCC for ≥180 s was successfully done in 42 (84%) neonates. The mean duration of DCC was 170±27 s. HR and SpO2 at 1 min were recorded successfully in 92% of the babies. The majority of the maternal and neonatal care provider strongly supported the use of ICR trolley.ConclusionWe developed an ICR trolley and successfully tested the feasibility and acceptability of its use in healthy neonates undergoing DCC.

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Ott, Friederike, Angela Kribs, Patrick Stelzl, Ioannis Kyvernitakis, Michael Ehlen, Susanne Schmidtke, Tamina Rawnaq-Möllers, Werner Rath, Richard Berger, and Holger Maul. "Resuscitation of Term Compromised and Asphyctic Newborns: Better with Intact Umbilical Cord?" Geburtshilfe und Frauenheilkunde, June 23, 2022. http://dx.doi.org/10.1055/a-1804-3268.

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AbstractThe authors hypothesize that particularly severely compromised and asphyctic term infants in need of resuscitation may benefit from delayed umbilical cord clamping (after several minutes). Although evidence is sparse, the underlying pathophysiological mechanisms support this assumption. For this review the authors have analyzed the available research. Based on these data they conclude that it may be unfavorable to immediately clamp the cord of asphyctic newborns (e.g., after shoulder dystocia) although recommended in current guidelines to provide quick neonatological support. Compression of the umbilical cord or thorax obstructs venous flow to the fetus more than arterial flow to the placenta. The fetus is consequently cut off from a supply of oxygenated, venous blood. This may cause not only hypoxemia and consecutive hypoxia during delivery but possibly also hypovolemia. Immediate cord clamping may aggravate the situation of the already compromised newborn, particularly if the cord is cut before the lungs are ventilated. By contrast, delayed cord clamping leads to fetoplacental transfusion of oxygenated venous blood, which may buffer an existing acidosis. Furthermore, it may enhance blood volume by up to 20%, leading to higher levels of various blood components, such as red and white blood cells, thrombocytes, mesenchymal stem cells, immunoglobulins, and iron. In addition, the resulting increase in pulmonary perfusion may compensate for an existing hypoxemia or hypoxia. Early cord clamping before lung perfusion reduces the preload of the left ventricle and hinders the establishment of sufficient circulation. Animal models and clinical trials support this opinion. The authors raise the question whether it would be better to resuscitate compromised newborns with intact umbilical cords. Obstetric and neonatal teams need to work even closer together to improve neonatal outcomes.

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Yamada, Nicole K., Edgardo Szyld, Marya L. Strand, Emer Finan, Jessica L. Illuzzi, Beena D. Kamath-Rayne, Vishal S. Kapadia, et al. "2023 American Heart Association and American Academy of Pediatrics Focused Update on Neonatal Resuscitation: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care." Pediatrics, November 16, 2023. http://dx.doi.org/10.1542/peds.2023-065030.

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This 2023 focused update to the neonatal resuscitation guidelines is based on 4 systematic reviews recently completed under the direction of the International Liaison Committee on Resuscitation Neonatal Life Support Task Force. Systematic reviewers and content experts from this task force performed comprehensive reviews of the scientific literature on umbilical cord management in preterm, late preterm, and term newborn infants, and the optimal devices and interfaces used for administering positive-pressure ventilation during resuscitation of newborn infants. These recommendations provide new guidance on the use of intact umbilical cord milking, device selection for administering positive-pressure ventilation, and an additional primary interface for administering positive-pressure ventilation.

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Yamada, Nicole K., Edgardo Szyld, Marya L. Strand, Emer Finan, Jessica L. Illuzzi, Beena D. Kamath-Rayne, Vishal S. Kapadia, et al. "2023 American Heart Association and American Academy of Pediatrics Focused Update on Neonatal Resuscitation: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care." Circulation, November 16, 2023. http://dx.doi.org/10.1161/cir.0000000000001181.

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This 2023 focused update to the neonatal resuscitation guidelines is based on 4 systematic reviews recently completed under the direction of the International Liaison Committee on Resuscitation Neonatal Life Support Task Force. Systematic reviewers and content experts from this task force performed comprehensive reviews of the scientific literature on umbilical cord management in preterm, late preterm, and term newborn infants, and the optimal devices and interfaces used for administering positive-pressure ventilation during resuscitation of newborn infants. These recommendations provide new guidance on the use of intact umbilical cord milking, device selection for administering positive-pressure ventilation, and an additional primary interface for administering positive-pressure ventilation.

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Isacson, Manuela, Rejina Gurung, Omkar Basnet, Ola Andersson, and Ashish KC. "Neurodevelopmental outcomes of a randomised trial of intact cord resuscitation." Acta Paediatrica, June 25, 2020. http://dx.doi.org/10.1111/apa.15401.

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Hocq, Catheline, Aurianne Van Grambezen, Katherine Carkeek, Bénédicte Van Grambezen, Charles William Yoxall, Frédéric Debiève, Fiammetta Piersigilli, and Olivier Danhaive. "Implementing intact cord resuscitation in very preterm infants: feasibility and pitfalls." European Journal of Pediatrics, December 28, 2022. http://dx.doi.org/10.1007/s00431-022-04776-2.

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Zheng, Lixia, and Hong-yu Zhang. "Resuscitation with Intact Cord Reduces the Rate of Asphyxia at 5 Minutes." Obstetrics and Gynaecology Cases - Reviews 8, no. 5 (October 31, 2021). http://dx.doi.org/10.23937/2377-9004/1410214.

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Manchineni, Sai Bhavani, and Revat J. Meshram. "Revolutionizing Neonatal Care: A Comprehensive Review of Intact Cord Resuscitation in Newborns." Cureus, September 8, 2024. http://dx.doi.org/10.7759/cureus.68924.

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Malviya, Manoj N., Vishal Kapoor, Ranjit Torgalkar, Michelle Fiander, and Prakeshkumar S. Shah. "Newborn resuscitation with intact cord for non-vigorous term or late preterm infants." Cochrane Database of Systematic Reviews 2024, no. 3 (March 13, 2024). http://dx.doi.org/10.1002/14651858.cd014318.

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B, Santosh Avinash, Suresh Babu Mendu, Paramesh Pandala, Rakesh Kotha, and Venkata Narayana Yerraguntla. "Outcomes of Neonatal Resuscitation With and Without an Intact Umbilical Cord: A Meta-Analysis." Cureus, August 31, 2023. http://dx.doi.org/10.7759/cureus.44449.

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Teillet, Baptiste, Florian Manœuvrier, Céline Rougraff, Capucine Besengez, Laure Bernard, Anne Wojtanowski, Louise Ghesquieres, et al. "Intact cord resuscitation in newborns with congenital diaphragmatic hernia: insights from a lamb model." Frontiers in Pediatrics 11 (September 6, 2023). http://dx.doi.org/10.3389/fped.2023.1236556.

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Abstract:

IntroductionCongenital diaphragmatic hernia (CDH) is a rare condition characterized by pulmonary hypoplasia, vascular dystrophy, and pulmonary hypertension at birth. Validation of the lamb model as an accurate representation of human CDH is essential to translating research findings into clinical practice and understanding disease mechanisms. This article emphasizes the importance of validating the lamb model to study CDH pathogenesis and develop innovative therapeutics.Material and methodsAt 78 days of gestation, the fetal lamb's left forelimb was exposed through a midline laparotomy and hysterotomy, and a supra diaphragmatic thoracotomy was performed to allow the digestive organs to ascend into the thoracic cavity. At 138 ± 3 days of gestation, lambs were delivered via a cesarean section; then, with umbilical cord intact during 1 hour, the lambs were mechanically ventilated with gentle ventilation in a pressure-controlled mode for 2 h.ResultsCDH lambs exhibited a lower left lung-to-body weight ratio of 5.3 (2.03), p < 0.05, and right lung-to-body weight ratio of 8.2 (3.1), p < 0.05. They reached lower Vt/kg (tidal volume per kg) during the course of the resuscitation period with 1.2 (0.7) ml/kg at 10 min and 3 (1.65) ml/kg at 60 min (p < 0.05). Compliance of the respiratory system was lower in CDH lambs with 0.5 (0.3) ml/cmH2O at 60 min (p < 0.05) and 0.9 (0.26) ml/cmH2O at 120 min (p < 0.05). Differences between pre- and postductal SpO2 were higher with 15.1% (21.4%) at 20 min and 6.7% (14.5%) at 80 min (p < 0.05). CDH lambs had lower differences between inspired and expired oxygen fractions with 4.55% (6.84%) at 20 min and 6.72% (8.57%) at 60 min (p < 0.05). CDH lamb had lower left ventricle [2.73 (0.5) g/kg, p < 0.05] and lower right ventricle [0.69 (0.8), p < 0.05] to left ventricle ratio.DiscussionCDH lambs had significantly lower tidal volume than control lambs due to lower compliance of the respiratory system and higher airway resistance. These respiratory changes are characteristic of CDH infants and are associated with higher mortality rates. CDH lambs also exhibited pulmonary hypertension, pulmonary hypoplasia, and left ventricle hypoplasia, consistent with observations in human newborns. To conclude, our lamb model successfully provides a reliable representation of CDH and can be used to study its pathophysiology and potential interventions.

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Patriksson, Katarina, Ola Andersson, Filippa Stierna, Kristina Haglund, and Li Thies-Lagergren. "Midwives’ Experiences of Intact Cord Resuscitation in Nonvigorous Neonates After Vaginal Birth in Sweden." Journal of Obstetric, Gynecologic & Neonatal Nursing, January 2024. http://dx.doi.org/10.1016/j.jogn.2023.12.003.

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Journal articles on the topic 'Intact Cord Resuscitation'

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