Article Text

EFFECTS OF LATE CORD CLAMPING ON CEREBRAL AND SYSTEMIC CIRCULATION IN PREMATURE INFANTS (VERY LOW BIRTH WEIGHT)
  1. M Nelle1,
  2. B Gharavi1,
  3. O Linderkamp2,
  4. C Hoecker2
  1. 1University Children’s Hospital Berne, Bern, Switzerland
  2. 2University Children’s Hospital Heidelberg, Heidelberg, Germany

Abstract

Aims To investigate the effects of late versus early cord clamping on systemic circulation and cerebral blood flow velocity in premature infants <1500 g (very low birth weight).

Subjects 34 neonates were studied 4 h after caesarean section. In 18 neonates (birth weight 1240 ± 290 g; gestational age 30.0 ± 2 weeks) the umbilical cords were clamped after 30 s and the infants were placed 30 cm below placenta level (late CC), and in 16 (1231 ± 350 g; 28.6 ± 2 weeks) the cords were clamped immediately (early CC). Volume expansion (serum or plasma) were given to keep the mean blood pressure (MBP) >30 mm Hg.

Methods MBP (mm Hg), left ventricular output (LVO, ml/kg per minute), mean cerebral blood flow velocity in the arteria carotis interna (ACI, m/s; Doppler ultrasound), haemoglobin (g/dl), and haematocrit (%) were measured. Systemic and cerebral haemoglobin transport (HbT), and systemic vascular resistance (SVR; mm Hg/kg per minute) were estimated. Statistics: Unpaired* t test.

Results (4 h after birth). Parameter: early CC versus late CC, *p value. MBP 36 ± 4 versus 44 ± 7, p = 0.03; LVO 241 ± 38 versus 245 ± 25, NS; ACI 0.16 ± 0.03 versus 0.20 ± 0.05, NS; SVR 123 ± 40 versus 145 ± 30, p = 0.05; haematocrit 0.46 ± 0.4 versus 0.55 ± 0.5, p = 0.02; cerebral HbT 7.4 ± 1.8 versus 11.1 ± 4.1, p = 0.04; systemic HbT 154 ± 27 versus 181 ± 24, p = 0.05.

Conclusions Late cord clamping improves MBP, SVR, haemoglobin, systemic and cerebral HbT in prematures <1500 g. The early cord clamped group required more volume expansion in the first 24 h (early 12/16, 14 ± 7 ml/kg; late 4/18, 5 ± 4 ml/kg; p<0.03).

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