Universität zu Köln

Ott, Friederike, Kribs, Angela, Stelzl, Patrick, Kyvernitakis, Ioannis ORCID: 0000-0002-8721-5818, Ehlen, Michael, Schmidtke, Susanne, Rawnaq-Mollers, Tamina, Rath, Werner, Berger, Richard and Maul, Holger (2022). Resuscitation of Term Compromised and Asphyctic Newborns: Better with Intact Umbilical Cord? Geburtshilfe Frauenheilkd., 82 (7). S. 706 - 719. STUTTGART: GEORG THIEME VERLAG KG. ISSN 1438-8804

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Abstract

The authors hypothesize that particularly severely compromised and asphyctic term infants in need of resuscitation may benefit from delayed umbilical cord clamping (after several minutes). Although evidence is sparse, the underlying pathophysiological mechanisms support this assumption. For this review the authors have analyzed the available research. Based on these data they conclude that it may be unfavorable to immediately clamp the cord of asphyctic newborns (e.g., after shoulder dystocia) although recommended in current guidelines to provide quick neonatological support. Compression of the umbilical cord or thorax obstructs venous flow to the fetus more than arterial flow to the placenta. The fetus is consequently cut off from a supply of oxygenated, venous blood. This may cause not only hypoxemia and consecutive hypoxia during delivery but possibly also hypovolemia. Immediate cord clamping may aggravate the situation of the already compromised newborn, particularly if the cord is cut before the lungs are ventilated. By contrast, delayed cord clamping leads to fetoplacental transfusion of oxygenated venous blood, which may buffer an existing acidosis. Furthermore, it may enhance blood volume by up to 20%, leading to higher levels of various blood components, such as red and white blood cells, thrombocytes, mesenchymal stem cells, immunoglobulins, and iron. In addition, the resulting increase in pulmonary perfusion may compensate for an existing hypoxemia or hypoxia. Early cord clamping before lung perfusion reduces the preload of the left ventricle and hinders the establishment of sufficient circulation. Animal models and clinical trials support this opinion. The authors raise the question whether it would be better to resuscitate compromised newborns with intact umbilical cords. Obstetric and neonatal teams need to work even closer together to improve neonatal outcomes.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Ott, Friederike UNSPECIFIED UNSPECIFIED UNSPECIFIED Kribs, Angela UNSPECIFIED UNSPECIFIED UNSPECIFIED Stelzl, Patrick UNSPECIFIED UNSPECIFIED UNSPECIFIED Kyvernitakis, Ioannis UNSPECIFIED orcid.org/0000-0002-8721-5818 UNSPECIFIED Ehlen, Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED Schmidtke, Susanne UNSPECIFIED UNSPECIFIED UNSPECIFIED Rawnaq-Mollers, Tamina UNSPECIFIED UNSPECIFIED UNSPECIFIED Rath, Werner UNSPECIFIED UNSPECIFIED UNSPECIFIED Berger, Richard UNSPECIFIED UNSPECIFIED UNSPECIFIED Maul, Holger UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-687177
DOI:	10.1055/a-1804-3268
Journal or Publication Title:	Geburtshilfe Frauenheilkd.
Volume:	82
Number:	7
Page Range:	S. 706 - 719
Date:	2022
Publisher:	GEORG THIEME VERLAG KG
Place of Publication:	STUTTGART
ISSN:	1438-8804
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language BIRTH; INFANTS; BLOOD; FEASIBILITY; VENTILATION; ONSET Multiple languages Obstetrics & Gynecology Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/68717