Effect of timing of umbilical cord clamping on cerebral tissue oxygen saturation in term and preterm infants

• Applicant: Privatdozentin Dr. Laila Springer
• Subject Area: Pediatric and Adolescent Medicine ; Gynaecology and Obstetrics
• Term: from 2014 to 2017
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 267138352

Umbilical cord clamping is one of the oldest medical procedures. However, the best time to clamp the cord remains uncertain.There is evidence that delayed cord clamping (90 to 180 s) improves the chances of survival without cerebral hemorrhage in preterm infants. The increased blood volume of the newborn resulting from placental transfusion after delayed cord clamping is thought to be the primary cause for the benefits observed in preterm infants. However, there is insufficient evidence of a beneficial effect of delayed cord clamping in term infants, and early cord clamping continues to be standard practice in term and near term infants.It is well known that most term infants cry and breathe soon after birth, I.e. before the umbilical cord is clamped. Early cord clamping (< 20 s) may result in a disruption of placental circulation before the infant takes its first breath, preventing physiological adaptation and possibly leading to cardiovascular disturbances.Within the framework of a prospective randomized controlled trial in term and preterm infants, this study will answer the question of which time of cord clamping is best: early cord clamping (< 20 s), delayed cord clamping (90 to 180 s) or cord clamping 10 s after breathing is established. Primary and key secondary outcome measures will be the incidence of bradycardia (heart rate < 100 bpm), arterial oxygen saturation and cerebral tissue oxygenation. The findings of this study will help to better understand the physiological processes during fetal to neonatal transition. Moreover, the established reference ranges for heart rate and oxygen saturations within the first 10 min of life were obtained in a population of babies undergoing early cord clamping. These studies need to be repeated to determine whether the timing of cord clamping influences these reference ranges. Findings from the proposed study may alter international resuscitation guidelines.

• DFG Programme: Research Fellowships
• International Connection: Australia
• Host: Professor Dr. Peter Graham Davis