The effect of placental transfusion on hemodynamics in premature newborns: a randomized controlled trial

Eur J Pediatr. 2022 Dec;181(12):4121-4133. doi: 10.1007/s00431-022-04619-0. Epub 2022 Sep 21.

Abstract

Despite of growing evidence of the beneficial effects of placental transfusion techniques, there is no available sufficient data about their effects on vulnerable hemodynamics and myocardium of premature infants. The purpose of this work is to study ventricular functions and hemodynamics after applying different placental transfusion techniques, delayed cord clamping (DCC), cut cord milking (C-UCM), and intact cord milking (I-UCM). Sixty-four infants delivered whether by C-section or vaginal delivery were randomly assigned to undergo C-UCM (20-30 cm), I-UCM (3-4 strippings), and DCC (30-60 s). Functional echocardiography was done on day 1 and day 3 of life for 57 infants. Primary outcome variable was superior vena cava flow measurement in infants having placental transfusion in the first 24 h of life and between 64 and 72 h. Secondary outcomes were other echocardiographic and clinical hemodynamic parameters, and biventricular functions in those infants. Of a total 196 preterm infants ≤ 32 weeks delivered in the study period, from January 2021 to August 2021, 57 infants were eligible and survived till the second examination. They were randomly assigned to the three groups. Neonates randomly assigned to DCC had significantly higher superior vena cava flow and lower right ventricular systolic function in the first 24 h of life. This finding vanished at day 3. Neonates undergone different methods of placental transfusions had similar hemoglobin, admission temperature, and mean blood pressure in the first 24 h of life.

Conclusion: Despite their potential benefits, placental transfusions have shown to alter the hemodynamics and adversely affect myocardial function of premature neonates.

Trial registration: This trial was registered in the clinical trial gov NCT04811872.

What is known: • Placental transfusion techniques might have benefits regarding prematurity- related morbidities and mortality.

What is new: • Placental transfusion might adversely affect the myocardium and alter hemodynamics in premature infants.

Keywords: Cord milking; Delayed cord clamping; Fractional shortening; Superior vena cava flow.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Constriction
  • Female
  • Hemodynamics / physiology
  • Humans
  • Infant
  • Infant, Newborn
  • Infant, Premature*
  • Infant, Premature, Diseases*
  • Placenta / physiology
  • Pregnancy
  • Umbilical Cord
  • Umbilical Cord Clamping
  • Vena Cava, Superior / diagnostic imaging
  • Vena Cava, Superior / physiology

Associated data

  • ClinicalTrials.gov/NCT04811872