Placental Transfusion during Neonatal Resuscitation in an Asphyxiated Preterm Model

BACKGROUND: Neonatal Resuscitation Program does not recommend placental transfusion in depressed preterm neonates. METHODS: Our objectives were to study the effect of delayed cord clamping (DCC) with ventilation for 5 minutes (DCCV, n-5), umbilical cord milking (UCM) without ventilation (n-6), UCM with ventilation (UCMV, n-6), early cord clamping followed by ventilation (ECCV, n-6) on red cell volume (RCV), and hemodynamic changes in asphyxiated preterm lambs. Twenty-three preterm lambs at 127–128d gestation were randomized to DCCV, UCM, UCMV, and ECCV. We defined asphyxia as heart rate < 100/minute. RESULTS: The UCMV had the highest neonatal RCV as a percentage of fetoplacental volume compared to the other groups (UCMV 85.5±10%, UCM 72±10%, ECCV 65±14%, DCCV 61±10%, p<0.01). The DCCV led to better ventilation (66±1 mmHg) and higher pulmonary blood flow (75±24 ml/kg/min). The carotid flow was significantly higher in UCM without ventilation. The fluctuations in carotid flow with milking were 25±6% higher from baseline during UCM, compared to 6±3% in UCMV (p<0.01). CONCLUSION: Cord milking with ventilation led to higher RCV than other interventions. Ventilation during cord milking reduced fluctuation in carotid flow compared to UCM alone. DCCV led to better ventilation and pulmonary blood flow but did not increase RCV.