Effects of different ways of umbilical cord milking on the outcome of very preterm infants

doi:10.11852/zgetbjzz2021-1602

Abstract

Abstract: Objective To investigate the effect of different ways of umbilical cord milking(UCM) on the hemoglobin level and complication incidences in very preterm infants, so as to provide reference for choosing appropriate way of UCM in clinic. Methods From May 2018 to May 2021,a total of 262 cases of very preterm infants delivered via vagina in Zhongshan Hospital Affiliated to Xiamen University with gestational age of 28 to 31⁺⁶weeks were divided into intact umbilical cord milking(I-UCM) group(n=87), cut-umbilical cord milking(C-UCM) group(n=88), immediate cord milking(ICC) group(n=87) according to different umbilical cord clamping methods. The hemoglobin level, hematocrit, serum total bilirubin level, phototherapy rate and transfusion rate during hospitalization of very preterm infants were compared among three groups. Besides, peri/intraventricular hemorrhage, neonatal necrotizing enterocolitis(NEC), retinopathy of prematurity(ROP), bronchopulmonary dysplasia(BPD), neonatal hypoglycemia and neonatal hypothermia were also compared among three groups. Results The levels of hemoglobin and hematocritin 1 hour after birth in I-UCM group and C-UCM group were significantly higher than those in ICC group(F=26.754, 29.147, P＜0.001), which were even higher in I-UCM group than C-UCM group(P<0.001). Serum total bilirubin level in the third and fifth day after birth in both groups of I-UCM and C-UCM were higher than those in group ICC(F=4.319,7.117, P=0.014). The incidence rates of peri/intraventricular hemorrhage(χ²=10.261), NEC(χ²=6.512), hypoglycemia and hypothermia(χ²=13.198) in both I-UCM group and C-UCM group were significantly lower than those in ICC group(P<0.05). There were no significant differences in the incidence rates of ROP, BPD and the proportion of phototherapyduring hospitalization in very preterm among the three groups(P>0.05). Conclusions Both I-UCM and C-UCM can effectively increase the blood volume of very preterm infants. The two UCM methods have similar effects on reducing the incidence of peri/ventricular hemorrhage, NEC, neonatal hypoglycemia, neonatal hypothermia and blood transfusion rate of very preterm infants.

Key words: umbilical cord milking, hemoglobin, very preterm infants

摘要： 目的探讨不同方式脐带挤压(UCM)对极早产儿血红蛋白水平及并发症发生率的影响,为临床上选择合适的脐带处理方式提供参考。方法收集2018年5月—2021年5月在厦门大学附属中山医院出生胎龄28～31⁺⁶周经阴道分娩的极早产儿共262例作为研究对象,按照不同脐带处理方式分为脐带挤压后断脐(I-UCM)组87例,断脐后脐带挤压(C-UCM)组88例,立即脐带结扎(ICC)组87例。比较各组血红蛋白水平和红细胞压积、血清总胆红素水平和光疗率、脑室周围-脑室内出血、新生儿坏死性小肠结肠炎、早产儿视网膜病变、支气管肺发育不良、新生儿低血糖、新生儿低体温的发生率。结果 I-UCM组和C-UCM组极早产儿生后1小时血红蛋白水平、红细胞压积高于ICC组(F=26.754、29.147,P＜0.001),I-UCM组均高于C-UCM组(P＜0.001);I-UCM组和C-UCM组极早产儿生后第3天和第5天血清总胆红素水平均高于ICC组(F=4.324、7.117,P=0.014);I-UCM组和C-UCM组极早产儿脑室周围-脑室内出血(χ²=10.261)、新生儿坏死性小肠结肠炎(χ²=6.512)、低血糖、低体温(χ²=13.198)的发生率和住院期间输血率(χ²=8.724)均低于ICC组(P<0.05);三组极早产儿视网膜病变、支气管肺发育不良的发生率和住院期间总光疗率比较,差异无统计学意义(P＞0.05)。结论 I-UCM和C-UCM均可有效增加极早产儿血容量。两种脐带挤压方式对于降低脑室周围-脑室内出血、新生儿坏死性小肠结肠炎、新生儿低血糖、新生儿低体温的发生率以及极早产儿输血率的效果相似。

关键词: 脐带挤压, 血红蛋白, 极早产儿

CLC Number:

R722.6

FENG Xiao, CHEN Ling, ZHAO Hongying, HUANG Rui, LIN Chenxi, ZHUANG Lijuan. Effects of different ways of umbilical cord milking on the outcome of very preterm infants[J]. Chinese Journal of Child Health Care, 2023, 31(7): 794-798.

冯骁, 陈凌, 赵红缨, 黄蕊, 林辰曦, 庄丽娟. 不同脐带挤压方式对极早产儿结局的影响[J]. 中国儿童保健杂志, 2023, 31(7): 794-798.

References

[1] Khasawneh W, Khriesat W. Assessment and comparison of mortality and short-term outcomes among premature infants before and after 32-week gestation: A cross-sectional analysis[J]. Ann Med Surg (Lond),2020, 60:44-49.
[2] Mercer JS, EricksonOwens DA, Rabe H. Placental transfusion: may the "force" be with the baby[J]. J Perinatol, 2021,41(6):1495-1504.
[3] Committee opinion No. 684 summary: Delayed umbilical cord clamping after birth[J]. Obstet Gynecol, 2017, 129:232-233.
[4] 刘誉,杨慧霞. 2020年美国妇产科医师协会分娩后延迟脐带结扎的专家共识解读[J]. 中华妇产科杂志, 2021,56(7):515-518.
Li Y,Yang HX. Interpretation of 2020 American College of Obstetricians and Gynecologists Committee Opinion: Delayed umbilical cord clamping after birth[J]. Chin J Obstet Gynecol, 2021, 56(7): 516-518.(in Chinese)
[5] Anup CK, Jeff MS, Jochen E, et al. Early cardiac and cerebral hemodynamics with umbilical cord milking compared with delayed cord clamping in infants born preterm[J]. J Pediatr, 2020, 223:51-56.
[6] Katheria AC, Lakshminrusimha S, Rabe H, et al. Placental transfiision:A review[J]. J Perinatol, 2017, 37(2):105-111.
[7] Simonin A, Safarulla A, Farmer Z, et al. Cut umbilical cord milking: An ineffective method of placental transfusion in preterm infants?[J]. Arch Dis Child Fetal Neonatal Ed, 2020, 33(18):3132-3135.
[8] Panburana P, Odthon T, Pongmee P. The effect of umbilical cord milking compared with delayed cord clamping in term neonates: A randomized controlled trial[J]. Int J Womens Health, 2020, 12:301-306.
[9] 中华医学会儿科学分会新生儿学组. 新生儿高胆红素血症诊断和治疗的专家共识[J].中华儿科杂志, 2014, 52(10):745-748.
[10] 邵肖梅,叶鸿瑁,丘小汕.实用新生儿学[M].5版.北京:人民卫生出版社,2019.
Shao XM,Ye HM,Qiu XS.Practice of neonatiology[M].5^th ed.Beijing:People′s Medical Publishing House,2019.(in Chinese)
[11] Kuik SJ, Kalteren WS, Mebius MJ, et al. Predicting intestinal recovery after necrotizing enterocolitis in preterm infants[J]. Pediatr Res, 2020, 87(5):903-909.
[12] 中华医学会儿科学分会新生儿学组,中华儿科杂志编辑委员会. 早产儿支气管肺发育不良临床管理专家共识[J].中华儿科杂志,2020, 58(5):358-365.
The Subspecialty Group of Neonatology, the Society of Pediatrics, Chinese Medical Association,the Editorial Board, Chinese Journal of Pediatrics. Expert consensus on clinical management of premature infants with brochopulmonary dysplasia[J]. Chin J Pediatr, 2020,58(5): 358-365.(in Chinese)
[13] Jones JG, Holland BM, HudsonI R, et al. Total circulating red blood cells versus haematocrit as the primary descriptor of oxygen transport by the blood[J]. Br J Haematol, 1990, 76:288-294.
[14] Shao HL, Gao SC, Lu QJ, et al. Effects of delayed cord clamping on neonatal jaundice, phototherapy and early hematological status in term cesarean section[J]. Ital J Pediatr, 2021, 47(1):115.
[15] De BG, Giordano M, De SR, et al. A randomized controlled study of immediate versus delayed umbilical cord clamping in infants born by elective caesarean section[J]. Ital J Pediatr, 2020, 46(1):71.
[16] Ryan MM, Emily F, Shani D, et al. Whole blood volumes associated with milking intact and cut umbilical cords in term newborns[J]. J Perinatol, 2018, 38(3):245-250.
[17] Boere I, Roest AA, Wallace E, et al. Umbilical blood flow patterns directly after birth before delayed cord clamping[J]. Arch Dis Child Fetal Neonatal Ed, 2015, 100:121-125.
[18] Garton T, Hua Y, Xiang J, et al. Challenges for intraventricular hemorrhage research and emerging therapeutic targets[J]. Expert Opin Ther Targets, 2017, 21(12):1111-1122.
[19] Sweta B, Xuxin C, Heather H, et al. Purnahamsi desaioptimal timing and methodology of umbilical cord clamping in preterm infants: A review[J]. Current Pediatrics Reports, 2019, 7(3):90-98.
[20] Qian YY, Ying XX, Wang PX, et al. Early versus delayed umbilical cord clamping on maternal and neonatal outcomes[J]. Arch Gynecol Obstet,2019, 300(3):531-543.