Introduction Delaying umbilical cord clamping facilitates postnatal transition in neonates but evidence on its effect in reducing hemodynamic instability in preterm neonates is inconclusive. Aims To evaluate delayed cord clamping (DCC) in reducing the incidence of hemodynamic instability in preterm neonates below 35 weeks gestational age admitted to the neonatal intensive care unit. Methods Neonates between 25 weeks and 34 weeks and 6 days gestation were enrolled. Hemodynamic and respiratory parameters were monitored over 48 h. Hemodynamic instability was defined as persistent tachycardia and/or hypotension necessitating therapy. Results The DCC cohort included 62 neonates with an equal number in the non-DCC group. The birth weight [mean ± standard deviation (SD)] was 1332.90 ± 390.05 g and the gestational age (mean ± SD) was 31.64 ± 2.52 weeks. Hemodynamic instability was noted in 18/62 (29%) neonates in the DCC cohort and 29/62 (46.7%) in the non-DCC group; relative risk (RR) 0.62 [95% confidence interval (CI) 0.38–0.99] (p = 0.023). The duration of inotrope requirement in the DCC cohort (mean ± SD) was 38.38 ± 16.99 h compared to 49.13 ± 22.90 h in the non-DCC cohort (p = 0.090). Significantly higher systolic, diastolic and mean arterial pressures were noted from 6 h to 48 h in the DCC cohort (p < 0.001). The severity of respiratory distress and FiO2 requirement was also less in the first 24 h. There was no difference in the incidence of patent ductus arteriosus, late-onset sepsis or mortality. Conclusion Delaying umbilical cord clamping at birth by 60 s resulted in significantly lower hemodynamic instability in the first 48 h and higher blood pressure parameters.

中文翻译：

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延迟脐带夹闭对 35 周以下早产儿血流动力学不稳定的影响

简介 延迟脐带钳夹有助于新生儿的产后过渡，但其在减少早产新生儿血流动力学不稳定方面的作用的证据尚无定论。目的 评估延迟脐带钳夹 (DCC) 在减少入住新生儿重症监护病房的胎龄 35 周以下早产儿血流动力学不稳定的发生率。方法纳入孕25周至34周6天的新生儿。在 48 小时内监测血流动力学和呼吸参数。血流动力学不稳定被定义为持续性心动过速和/或需要治疗的低血压。结果 DCC 队列包括 62 名新生儿，在非 DCC 组中数量相等。出生体重 [平均 ± 标准差 (SD)] 为 1332.90 ± 390.05 g，胎龄 (平均 ± SD) 为 31.64 ± 2.52 周。DCC 队列中 18/62 (29%) 的新生儿和非 DCC 组中 29/62 (46.7%) 的新生儿出现血流动力学不稳定；相对风险 (RR) 0.62 [95% 置信区间 (CI) 0.38–0.99] (p = 0.023)。DCC 队列中的正性肌力药物需求持续时间（平均值 ± SD）为 38.38 ± 16.99 小时，而非 DCC 队列为 49.13 ± 22.90 小时（p = 0.090）。在 DCC 队列中，从 6 小时到 48 小时注意到显着更高的收缩压、舒张压和平均动脉压（p < 0.001）。在最初的 24 小时内，呼吸窘迫和 FiO2 需求的严重程度也较低。动脉导管未闭、迟发性败血症或死亡率的发生率没有差异。结论 将出生时脐带钳夹延迟 60 秒可显着降低最初 48 小时的血流动力学不稳定性和更高的血压参数。