PDF(Pubmed)
Abstract：
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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).
CONCLUSIONS: 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.
METHODS: 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.
RESULTS: 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).
CONCLUSIONS: 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.
摘要：
背景：根据世界卫生组织的建议，延迟脐带夹紧在足月新生儿可以有各种好处。Cochrane荟萃分析报告死亡率和早期新生儿发病率没有差异，尽管有限数量的研究调查了长期神经发育结局。我们研究的目的是比较选择性剖宫产后出生的早期和延迟脐带钳夹婴儿的出生后脑组织氧合值。
方法：在本研究中，共纳入80例择期剖宫产分娩的足月新生儿.婴儿被随机分组为早期(在15s内夹住，n：40）和延迟的电源线夹紧（在第60秒，n:40)组。通过脉搏血氧饱和度测量外周动脉血氧饱和度（SpO2）和心率，而使用近红外光谱仪测量大脑的局部氧饱和度（rSO2）。在出生后第3分钟至第15分钟之间，计算每分钟的组织氧提取分数（FTOE）。(FTOE=脉搏血氧饱和度值-rSO2/脉搏血氧饱和度值)。比较两组的测量值。
结果：人口统计学特征，SpO2水平（除了产后6，8th,第14分钟有利于DCCp<0.05)，心率和脐血血气值组间差异无统计学意义(p>0.05)。在延迟脐带钳夹组中，出生后第3分钟至第15分钟的每分钟rSO2值显着升高，而FTOE值显着降低（p<0.05）。
结论：我们的研究表明，延迟脐带钳夹（DCC）组的大脑rsO2值显着增加，而FTOE值降低，表明对脑氧合和血流动力学有积极影响。此外，DCC组脑rSO2水平高于第90百分位数的婴儿比例较高。这一比例较高,以及这些参数低于10个百分位数的较低的人，提示DCC可能导致这些婴儿的靶向/最佳脑氧合。因此,我们建议测量脑氧合,除了外周SpO2，对于经历围产期缺氧和接受补充氧气的婴儿。
方法：在本研究中，共纳入80例择期剖宫产分娩的足月新生儿.婴儿被随机分组为早期(在15s内夹住，n：40）和延迟的电源线夹紧（在第60秒，n:40)组。通过脉搏血氧饱和度测量外周动脉血氧饱和度（SpO2）和心率，而使用近红外光谱仪测量大脑的局部氧饱和度（rSO2）。在出生后第3分钟至第15分钟之间，计算每分钟的组织氧提取分数（FTOE）。(FTOE=脉搏血氧饱和度值-rSO2/脉搏血氧饱和度值)。比较两组的测量值。
结果：人口统计学特征，SpO2水平（除了产后6，8th,第14分钟有利于DCCp<0.05)，心率和脐血血气值组间差异无统计学意义(p>0.05)。在延迟脐带钳夹组中，出生后第3分钟至第15分钟的每分钟rSO2值显着升高，而FTOE值显着降低（p<0.05）。
结论：我们的研究表明，延迟脐带钳夹（DCC）组的大脑rsO2值显着增加，而FTOE值降低，表明对脑氧合和血流动力学有积极影响。此外，DCC组脑rSO2水平高于第90百分位数的婴儿比例较高。这一比例较高,以及这些参数低于10个百分位数的较低的人，提示DCC可能导致这些婴儿的靶向/最佳脑氧合。因此,我们建议测量脑氧合,除了外周SpO2，对于经历围产期缺氧和接受补充氧气的婴儿。
