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Italian Recommendations for Placental Transfusion Strategies

At delivery, if the cord is not clamped, blood continues to pass from the placenta to the newborn during the first minutes of life, allowing the transfer of 25–35 ml/kg of placental blood to the newborn, depending on gestational age, the timing of cord clamping, the position of the infant at birth,...

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Autores principales: Ghirardello, Stefano, Di Tommaso, Mariarosaria, Fiocchi, Stefano, Locatelli, Anna, Perrone, Barbara, Pratesi, Simone, Saracco, Paola
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6287578/
https://www.ncbi.nlm.nih.gov/pubmed/30560107
http://dx.doi.org/10.3389/fped.2018.00372
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author Ghirardello, Stefano
Di Tommaso, Mariarosaria
Fiocchi, Stefano
Locatelli, Anna
Perrone, Barbara
Pratesi, Simone
Saracco, Paola
author_facet Ghirardello, Stefano
Di Tommaso, Mariarosaria
Fiocchi, Stefano
Locatelli, Anna
Perrone, Barbara
Pratesi, Simone
Saracco, Paola
author_sort Ghirardello, Stefano
collection PubMed
description At delivery, if the cord is not clamped, blood continues to pass from the placenta to the newborn during the first minutes of life, allowing the transfer of 25–35 ml/kg of placental blood to the newborn, depending on gestational age, the timing of cord clamping, the position of the infant at birth, the onset of respiration, and administration of uterotonics to the mother. However, deriving benefits from delayed cord clamping (DCC) are not merely related to placental-to-fetal blood transfusion; establishing spontaneous ventilation before cutting the cord improves venous return to the right heart and pulmonary blood flow, protecting the newborn from the transient low cardiac output, and systemic arterial pressure fluctuations. Recent meta-analyses showed that delayed cord clamping reduces mortality and red blood cell transfusions in preterm newborns and increases iron stores in term newborns. Various authors suggested umbilical cord milking (UCM) as a safe alternative when delayed cord clamping is not feasible. Many scientific societies recommend waiting 30–60 s before clamping the cord for both term and preterm newborns not requiring resuscitation. To improve the uptake of placental transfusion strategies, in 2016 an Italian Task Force for the Management of Umbilical Cord Clamping drafted national recommendations for the management of cord clamping in term and preterm deliveries. The task force performed a detailed review of the literature using the GRADE methodological approach. The document analyzed all clinical scenarios that operators could deal with in the delivery room, including cord blood gas analysis during delayed cord clamping and time to cord clamping in the case of umbilical cord blood banking. The panel intended to promote a more physiological and individualized approach to cord clamping, specifically for the most preterm newborn. A feasible option to implement delayed cord clamping in very preterm deliveries is to move the neonatologist to the mother's bedside to assess the newborn's clinical condition at birth. This option could safely guarantee the first steps of stabilization before clamping the cord and allow DCC in the first 30 s of life, without delaying resuscitation. Contra-indications to placental transfusion strategies are clinical situations that may endanger mother ‘s health and those that may delay immediate newborn's resuscitation when required.
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spelling pubmed-62875782018-12-17 Italian Recommendations for Placental Transfusion Strategies Ghirardello, Stefano Di Tommaso, Mariarosaria Fiocchi, Stefano Locatelli, Anna Perrone, Barbara Pratesi, Simone Saracco, Paola Front Pediatr Pediatrics At delivery, if the cord is not clamped, blood continues to pass from the placenta to the newborn during the first minutes of life, allowing the transfer of 25–35 ml/kg of placental blood to the newborn, depending on gestational age, the timing of cord clamping, the position of the infant at birth, the onset of respiration, and administration of uterotonics to the mother. However, deriving benefits from delayed cord clamping (DCC) are not merely related to placental-to-fetal blood transfusion; establishing spontaneous ventilation before cutting the cord improves venous return to the right heart and pulmonary blood flow, protecting the newborn from the transient low cardiac output, and systemic arterial pressure fluctuations. Recent meta-analyses showed that delayed cord clamping reduces mortality and red blood cell transfusions in preterm newborns and increases iron stores in term newborns. Various authors suggested umbilical cord milking (UCM) as a safe alternative when delayed cord clamping is not feasible. Many scientific societies recommend waiting 30–60 s before clamping the cord for both term and preterm newborns not requiring resuscitation. To improve the uptake of placental transfusion strategies, in 2016 an Italian Task Force for the Management of Umbilical Cord Clamping drafted national recommendations for the management of cord clamping in term and preterm deliveries. The task force performed a detailed review of the literature using the GRADE methodological approach. The document analyzed all clinical scenarios that operators could deal with in the delivery room, including cord blood gas analysis during delayed cord clamping and time to cord clamping in the case of umbilical cord blood banking. The panel intended to promote a more physiological and individualized approach to cord clamping, specifically for the most preterm newborn. A feasible option to implement delayed cord clamping in very preterm deliveries is to move the neonatologist to the mother's bedside to assess the newborn's clinical condition at birth. This option could safely guarantee the first steps of stabilization before clamping the cord and allow DCC in the first 30 s of life, without delaying resuscitation. Contra-indications to placental transfusion strategies are clinical situations that may endanger mother ‘s health and those that may delay immediate newborn's resuscitation when required. Frontiers Media S.A. 2018-12-03 /pmc/articles/PMC6287578/ /pubmed/30560107 http://dx.doi.org/10.3389/fped.2018.00372 Text en Copyright © 2018 Ghirardello, Di Tommaso, Fiocchi, Locatelli, Perrone, Pratesi and Saracco. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Pediatrics
Ghirardello, Stefano
Di Tommaso, Mariarosaria
Fiocchi, Stefano
Locatelli, Anna
Perrone, Barbara
Pratesi, Simone
Saracco, Paola
Italian Recommendations for Placental Transfusion Strategies
title Italian Recommendations for Placental Transfusion Strategies
title_full Italian Recommendations for Placental Transfusion Strategies
title_fullStr Italian Recommendations for Placental Transfusion Strategies
title_full_unstemmed Italian Recommendations for Placental Transfusion Strategies
title_short Italian Recommendations for Placental Transfusion Strategies
title_sort italian recommendations for placental transfusion strategies
topic Pediatrics
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6287578/
https://www.ncbi.nlm.nih.gov/pubmed/30560107
http://dx.doi.org/10.3389/fped.2018.00372
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