Baby-directed umbilical cord clamping: A feasibility study

• Published in: Resuscitation 2018-10, Vol.131, p.1-7
• Main Authors: Blank, Douglas A., Badurdeen, Shiraz, Omar F Kamlin, C., Jacobs, Susan E., Thio, Marta, Dawson, Jennifer A., Kane, Stefan C., Dennis, Alicia T., Polglase, Graeme R., Hooper, Stuart B., Davis, Peter G.
• Format: Article
• Language: English
• Subjects: Cesarean; Cohort Studies; Constriction; Delayed cord clamping; Delivery, Obstetric - methods; ECG; Feasibility Studies; Female; Heart rate; Humans; Infant, Newborn; Male; Newborn; Pregnancy; Pulmonary Gas Exchange - physiology; Resuscitation; Resuscitation - methods; Time Factors; Umbilical Cord - blood supply; Uterotonic medication
• ISSN: 0300-9572; 1873-1570
• DOI: 10.1016/j.resuscitation.2018.07.020

Over five percent of infants born worldwide will need help breathing after birth. Delayed cord clamping (DCC) has become the standard of care for vigorous infants. DCC in non-vigorous infants is uncommon because of logistical difficulties in providing effective resuscitation during DCC. In Baby-Directed Umbilical Cord Clamping (Baby-DUCC), the umbilical cord remains patent until the infant’s lungs are exchanging gases. We conducted a feasibility study of the Baby-DUCC technique. We obtained antenatal consent from pregnant women to enroll infants born at ≥32 weeks. Vigorous infants received ≥2 min of DCC. If the infant received respiratory support, the umbilical cord was clamped ≥60 s after the colorimetric carbon dioxide detector turned yellow. Maternal uterotonic medication was administered after umbilical cord clamping. A paediatrician and researcher entered the sterile field to provide respiratory support during a cesarean birth. Maternal and infant outcomes in the delivery room and prior to hospital discharge were analysed. Forty-four infants were enrolled, 23 delivered via cesarean section (8 unplanned) and 15 delivered vaginally (6 via instrumentation). Twelve infants were non-vigorous. ECG was the preferred method for recording HR. Two infants had a HR 100 BPM by 80 s after birth. Median time to umbilical cord clamping was 150 and 138 s in vigorous and non-vigorous infants, respectively. Median maternal blood loss was 300 ml. It is feasible to provide resuscitation to term and near-term infants during DCC, after both vaginal and cesarean births, clamping the umbilical cord only when the infant is physiologically ready.