In the current era of DCC, outline current approaches to cord management in preterm infants not breathing soon after delivery

Sunday, April 30, 2023

11:00 AM – 12:30 PM ET

Location: Convention Center: 146 B

CE: Live CME: 1.50

Selected By: Neonatal

Chair(s)

Michael Meyer, MBChB FRACP MD (he/him/his)

Neonatologist and Hon Assoc Professor
University of Auckland
Auckland, Auckland, New Zealand

Disclosure(s):

Michael P. Meyer, MD MRCP FRACP: No financial relationships to disclose

Session

Description: There is a large body of evidence that has now demonstrated that delayed umbilical cord clamping (DCC) has benefits for term and preterm infants. These benefits include reductions in morbidities and mortality in preterm infants. One important group that has not been included is the nonbreathing, non-vigorous preterm infant. It may be important to determine whether an infant has started to breathe before the umbilical cord is clamped. This has been suggested in a number of small studies where infants who breathed had less blood retained in the placenta and higher hematocrits. Preterm infants also take longer to establish breathing than term newborns, placing greater emphasis on the determination of breathing before the cord is clamped. Animal data recently has been conflicting with some studies showing a hemodynamic benefit, while other demonstrating no difference if ventilation is started before cord clamping. This session will review the translation from bench to bedside, with evidence from cord clamping trials to date. Other strategies such as cord milking and early cord clamping when delayed cord clamping cannot be performed will also be discussed. Lastly, the challenges and future direction of cord clamping studies will be reviewed.

Learning Objectives:

Upon completion, participants will be able to understand the translation of animal to human data for potential benefits of delayed cord clamping.
Upon completion, participants will be able to explore the knowledge gaps, challenges, and future directions for cord clamping research.
Upon completion, participants will be able to review the evidence or (or lack thereof) from the current trials to inform current practice

Presentations:

11:00 AM – 11:15 AM ET

Translation of the evidence: What can and can't we take away from animal cord clamping models to understand human physiology
Speaker: Satyan Lakshminrusimha, MD FAAP (he/him/his) – UC Davis Children's Hospital
11:15 AM – 11:30 AM ET

DCC in preterms not breathing well at birth: evidence and lessons learned from two randomized controlled trials (Part 1), Q&A
Speaker: Michael P. Meyer, MBChB FRACP MD (he/him/his) – University of Auckland
11:30 AM – 11:40 AM ET

Cord milking versus early cord clamping: is there a role for preterm non-vigorous newborns
Speaker: Simone Pratesi, MD, PhD (he/him/his) – Careggi University Hospital Florence
11:40 AM – 11:50 AM ET

Physiological based cord clamping: Is it better than a time based approach?
Speaker: Ronny Knol, MD – Erasmus Medical Centre - Sophia Children's Hospital
11:50 AM – 12:00 PM ET

DCC in preterms not breathing well at birth: evidence and lessons learned from two randomized controlled trials (Part 2)
Speaker: Karen Fairchild, MD – University of Virginia School of Medicine
12:00 PM – 12:10 PM ET

Future directions optimizing cord clamping in preterm infants: Is more really better?
Speaker: Anup Katheria, MD – Sharp Mary Birch Neoanatal Research Institute, University of California, San Diego School of Medicine