Timing of cord clamping in relation to start of breathing or ventilation among depressed neonates—an observational study

• Published in: BJOG : an international journal of obstetrics and gynaecology 2016-07, Vol.123 (8), p.1370-1377
• Main Authors: Ersdal, HL, Linde, J, Auestad, B, Mduma, E, Lyanga, S, Svensen, E, Perlman, J
• Format: Article
• Language: English
• Subjects: Births; Infant mortality; Neonatal care; Neonatal mortality and morbidity; Respiration; resuscitation; umbilical cord clamping
• ISSN: 1470-0328; 1471-0528
• DOI: 10.1111/1471-0528.13778

Objectives The optimal timing of cord clamping (CC) in nonbreathing neonates needing stabilisation/resuscitation remains unclear. The objective was to describe the relationship between time to CC, initiation of breathing or positive pressure ventilation (PPV) after stimulation/suction and 24‐hour neonatal mortality/morbidity. Design Observational study. Setting A rural Tanzanian referral hospital. Population Depressed nonbreathing newborns. Methods Trained research assistants have observed every delivery (November 2009 through January 2014) using stop‐watches and recorded data including fetal heart rate; time intervals from birth to CC and start of breathing or PPV and perinatal characteristics. Main outcome measures Twenty‐four‐hour neonatal outcome (dead, admitted, normal). Results There were 19 863 liveborn infants; 16 770 (84.4%) initiated spontaneous respirations, 3093 (15.6%) received stimulation/suctioning to initiate breathing. However, 1269 (41.0%) neonates failed to breath and received PPV at 98 ± 66 seconds and CC at 39 ± 35 seconds after birth. Adverse outcomes in neonates receiving PPV included 126 (9.9%) deaths and 100 (7.8%) neonatal admissions. In 1146/1269 (90%) neonates, CC occurred before PPV and was associated with 209 (18%) deaths/admissions. In 98 (8%) neonates, CC followed initiation of PPV with 14 (14%) deaths/admissions (P = 0.328). By logistic modelling, initiation of PPV before versus after CC was not associated with death/admission when adjusted for time to PPV. The risk for death/admission increased by 12% for every 30‐second delay in PPV (P = 0.001). Conclusions This observational study failed to demonstrate any relationship between time to CC and onset of breathing or initiation of PPV following stimulation/suction, and 24‐hour outcome. Delay in initiation of PPV was significantly associated with death/admission. Tweetable No relationship between time to cord clamp, breathing or ventilation and 24‐hour deaths in depressed neonates. Tweetable No relationship between time to cord clamp, breathing or ventilation and 24‐hour deaths in depressed neonates.