Umbilical cord pulsation at the time of Delayed cord clamping in preterm infants
- Research Opportunity
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- Royal Children’s Hospital/Murdoch Childrens Research Institute
|Dr MD PhD Marta Thiofirstname.lastname@example.org||03 8345 3763|
|Dr RNN and Midwife Jennifer A Dawsonemail@example.com||03 8345 3763|
Delayed cord clamping (DCC) has been shown to smooth circulation transition after birth, especially if it is delayed until effective ventilation has been stablished. It has been proven to be safe in infants that do not need resuscitation interventions. Therefore, current consensus guidelines for neonatal resuscitation recommend incorporating DCC (1-3 minutes) into the care of vigorous newborns. This is due to the evidence that in most vigorous infants the cord stops pulsating ≤ 3 min. This means that the patent circulation between placenta and newborn infant, and therefore the physiological benefit of keeping the baby on the cord, would be over. If an infant is not vigorous or breathing after birth, the umbilical cord is currently cut so that the infant can be moved to a resuscitation platform where cardiorespiratory support can be provided.
Ideally, effective ventilation should be established within 1 min after birth. A recent multicentre randomised control trial compared DCC (≥ 60s) to ECC in preterm infants <30w. In the intervention arm (DCC), 73 % of infants had the cord clamped at median 60s (range 0-94s) to continue their stabilisation on a resuscitation bed. Whether the cord was still pulsating when the cord was clamped has not been reported.The remaining 27% of infants in the DCC arm had the cord clamped early due to clinician concerns.
The Royal Women’s Hospital’s DCC guideline states to clamp the umbilical cord at 60s in vigorous preterm infants <30w, so they can receive respiratory support on a resuscitation bed to establish or maintain their Functional Residual Capacity (FRC). In this observational study we aim to assess whether, in vigorous infants <30wGA, the cord has stopped pulsating when the cord is clamped at 60s. If the cord is still pulsating at 60s, this may change clinicians’ cord clamping approach in future studies, i.e. delaying cord clamping for longer, as it is currently performed in more mature infants.
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