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Respiratory support after delayed cord clamping: a prospective cohort study of at-risk births at ≥35+0 weeks gestation
Fetal & Neonatal ( IF 4.4 ) Pub Date : 2021-06-10 , DOI: 10.1136/archdischild-2020-321503
Shiraz Badurdeen 1, 2 , Georgia A Santomartino 3 , Marta Thio 3 , Alissa Heng 4 , Anthony Woodward 5 , Graeme R Polglase 2, 6 , Stuart B Hooper 2, 6 , Douglas A Blank 2, 7 , Peter G Davis 3
Affiliation  

Objective To identify risk factors associated with delivery room respiratory support in at-risk infants who are initially vigorous and received delayed cord clamping (DCC). Design Prospective cohort study. Setting Two perinatal centres in Melbourne, Australia. Patients At-risk infants born at ≥35+0 weeks gestation with a paediatric doctor in attendance who were initially vigorous and received DCC for >60 s. Main outcome measures Delivery room respiratory support defined as facemask positive pressure ventilation, continuous positive airway pressure and/or supplemental oxygen within 10 min of birth. Results Two hundred and ninety-eight infants born at a median (IQR) gestational age of 39+3 (38+2–40+2) weeks were included. Cord clamping occurred at a median (IQR) of 128 (123–145) s. Forty-four (15%) infants received respiratory support at a median of 214 (IQR 156–326) s after birth. Neonatal unit admission for respiratory distress occurred in 32% of infants receiving delivery room respiratory support vs 1% of infants who did not receive delivery room respiratory support (p<0.001). Risk factors independently associated with delivery room respiratory support were average heart rate (HR) at 90–120 s after birth (determined using three-lead ECG), mode of birth and time to establish regular cries. Decision tree analysis identified that infants at highest risk had an average HR of <165 beats per minute at 90–120 s after birth following caesarean section (risk of 39%). Infants with an average HR of ≥165 beats per minute at 90–120 s after birth were at low risk (5%). Conclusions We present a clinical decision pathway for at-risk infants who may benefit from close observation following DCC. Our findings provide a novel perspective of HR beyond the traditional threshold of 100 beats per minute. Data are available upon reasonable request. Sharing of data will be considered for specific research projects. Requests should be sent to the corresponding author.

中文翻译:

延迟脐带钳夹后的呼吸支持:妊娠≥35+0 周高危分娩的前瞻性队列研究

目的 确定与产房呼吸支持相关的危险因素,这些婴儿最初精力充沛并接受延迟脐带钳夹 (DCC)。设计前瞻性队列研究。在澳大利亚墨尔本设立两个围产中心。患者 妊娠≥35+0 周出生且有儿科医生在场的高危婴儿,他们最初精力充沛并接受 DCC 治疗 >60 秒。主要结局指标 产房呼吸支持定义为面罩正压通气、持续气道正压通气和/或出生后 10 分钟内补充氧气。结果 包括 298 名中位 (IQR) 胎龄 39+3 (38+2–40+2) 周出生的婴儿。脐带钳夹发生在 128 (123–145) 秒的中位数 (IQR) 时。44 名 (15%) 婴儿在出生后接受呼吸支持的中位数为 214 (IQR 156–326) 秒。接受产房呼吸支持的婴儿中有 32% 的婴儿因呼吸窘迫入院,而未接受产房呼吸支持的婴儿则为 1%(p<0.001)。与产房呼吸支持独立相关的危险因素是出生后 90-120 秒的平均心率 (HR)(使用三导联心电图确定)、出生方式和建立规律哭声的时间。决策树分析发现,剖宫产后出生后 90-120 秒内,风险最高的婴儿的平均 HR <165 次/分钟(风险为 39%)。出生后 90-120 秒内平均 HR ≥165 次/分钟的婴儿处于低风险 (5%)。结论 我们为可能从 DCC 后密切观察中受益的高危婴儿提供了临床决策途径。我们的研究结果提供了超越每分钟 100 次传统阈值的 HR 新视角。可应合理要求提供数据。对于特定的研究项目,将考虑共享数据。请求应发送给相应的作者。
更新日期:2021-06-11
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