The Baby Directed Umbilical Cord Cutting Physiology Study: A Randomised Controlled Trial (Baby-DUCC)
- Research Opportunity
- Number of Honour Places Available
- Obstetrics and Gynaecology
- Royal Women’s Hospital
|Dr Marta Thiofirstname.lastname@example.org||0450886176||Personal web page|
|Dr Douglas Blankemail@example.com||0422305487|
|Dr Shiraz Badurdeenfirstname.lastname@example.org||0490756768|
Summary Current neonatal resuscitation guidelines recommend that if an infant is not breathing at birth, the umbilical cord should be cut straight away so the infant can be transferred to a resuscitation platform where clinicians can provide resuscitation interventions. The aim of this study is to prove that supporting babies’ breathing before cutting the umbilical cord improves clinical outcomes, by ensuring oxygen transfer and blood flow are not interrupted whilst the baby is struggling to breathe.
Over 5% percent of all infants born worldwide will need help breathing after birth, including up to 12% of infants born under emergency conditions in Victoria. Currently, resuscitation guidelines state if an infant is not breathing after birth, the umbilical cord should cut so that the infant can be moved to a resuscitation platform where the clinician breaths for the infant by pushing air and oxygen into the newborn’s lung (positive pressure ventilation or PPV). Studies show that clinicians need 2 minutes to provide effective PPV. During that delay, the compromised infant is not receiving oxygen and the infant’s heart rate typically falls to a dangerously low rate.
We hypothesise that the compromised infant who needs help after birth will benefit from remaining connected to their mother and their placenta via the umbilical cord while a clinician is helping the infant breath. Maintaining the connection with the mother and the placenta through the umbilical cord provides the non-breathing infant fresh oxygen and good blood flow from the placenta while the infant is struggling to breath. We believe that improved oxygen levels and a normal heart rate in the first minutes of life may decrease the risk of death and significant brain damage in the newborn who isn’t breathing well. Birth asphyxia, or failure to initiate and sustain spontaneous breathing at birth, claims the lives of more than 800,000 infants every year, most of these infants die in resource limited countries. In large interventional studies, implementation of simple resuscitation techniques, dropped the rates of death from birth asphyxia by over 40%. Ventilation prior to umbilical cord clamping, or Baby-Directed Umbilical Cord Clamping (Baby-DUCC) may offer the next step in reducing the rates of death from birth asphyxia even further. The purpose of our trial is to prove that Baby-DUCC provides a physiological advantage over the current standard of care.
We are seeking a high-motivated student to help run the trial, including recruit and consent eligible patients, attend births to ensure adherence to the trial protocol and collect data, and analyse and present the data. We also will mentor our student to generate a novel “side-study” using data collected in the Baby-DUCC RCT. We will support our student from development of the side-study idea through the manuscript submission process until successful publication.
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