Early or delayed cord clamping during transition of term newborns: does it make any difference in cerebral tissue oxygenation?

TL;DR

This study found that delayed cord clamping in term newborns improves cerebral oxygenation compared to early clamping.

Contribution

The study provides new evidence on cerebral oxygenation differences between early and delayed cord clamping in term newborns.

Findings

Delayed cord clamping significantly increased cerebral rSO2 values in newborns.

Delayed cord clamping significantly decreased FTOE values in newborns.

DCC group had more infants with optimal cerebral oxygenation levels.

Abstract

According to the World Health Organization’s recommendation, delayed cord clamping in term newborns can have various benefits. Cochrane metaanalyses reported no differences for mortality and early neonatal morbidity although a limited number of studies investigated long-term neurodevelopmental outcomes. The aim of our study is to compare the postnatal cerebral tissue oxygenation values in babies with early versus delayed cord clamping born after elective cesarean section.

In this study, a total of 80 term newborns delivered by elective cesarean section were included. Infants were randomly grouped as early (clamped within 15 s, n:40) and delayed cord clamping (at the 60th second, n:40) groups. Peripheral arterial oxygen saturation (SpO2) and heart rate were measured by pulse oximetry while regional oxygen saturation of the brain (rSO2) was measured with near-infrared spectrometer. Fractional tissue oxygen extraction (FTOE) was calculated for every minute between the 3rd and 15th minute after birth. (FTOE = pulse oximetry value-rSO2/pulse oximetry value). The measurements were compared for both groups.

The demographical characteristics, SpO2 levels (except postnatal 6th, 8th, and 14th minutes favoring DCC p < 0.05), heart rates and umbilical cord blood gas values were not significantly different between the groups (p > 0.05). rSO2 values were significantly higher while FTOE values were significantly lower for every minute between the 3rd and 15th minutes after birth in the delayed cord clamping group (p < 0.05).

Our study revealed a significant increase in cerebral rsO2 values and a decrease in FTOE values in the delayed cord clamping (DCC) group, indicating a positive impact on cerebral oxygenation and hemodynamics. Furthermore, the DCC group exhibited a higher proportion of infants with cerebral rSO2 levels above the 90th percentile. This higher proportion, along with a lower of those with such parameter below the 10th percentile, suggest that DCC may lead to the targeted/optimal cerebral oxygenetaion of these babies. As a result, we recommend measuring cerebral oxygenation, in addition to peripheral SpO2, for infants experiencing perinatal hypoxia and receiving supplemental oxygen.