open access

Vol 91, No 10 (2020)
Research paper
Published online: 2020-10-21
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The risk of hyperbilirubinemia in term neonates after placental transfusion — a randomized-blinded controlled trial

Joanna P. Seliga-Siwecka, Joanna Puskarz-Gasowska, Justyna Tolloczko
DOI: 10.5603/GP.a2020.0096
·
Pubmed: 33184830
·
Ginekol Pol 2020;91(10):613-619.

open access

Vol 91, No 10 (2020)
ORIGINAL PAPERS Obstetrics
Published online: 2020-10-21

Abstract

Objective: We aimed to demonstrate non-inferiority of delayed cord clamping (DCC) and cord milking (CM) in comparison to early cord clamping (ECC) in the incidence of hyperbilirubinemia requiring phototherapy. Material and methods: 467 of maternal-foetal dyads were screened for eligibility. 389 term infants, of breastfeeding, non-smoking mothers were randomized to receive ECC ( < 40 s), DCC (1–2 min) or CM (4 times towards the neonate). The primary outcome was defined as hyperbilirubinemia requiring phototherapy. Results: 307 patients were included in the analysis. CM did not increase the risk of phototherapy RR 11.27 95% CI (0.80; 2.04). Similar results were achieved when comparing DCC and ECC, RR 1.29 95% CI (0.82; 2.05). This was also true for CM vs DCC, RR 0.99 95% CI (0.64; 1.52). The prevalence of total serum bilirubin (TSB) at 24–48 hours was 10.8 mg/dL; 10.33 mg/dL and 11.39 in ECC, CM and DCC group respectively. Transcutaneous bilirubin (TcB) levels at 24–48 h were 7.58 mg/dL, 7.89 mg/dL and 7.60 mg/dL in the ECC, CM and DCC respectively. None of the neonates met exchange transfusion criteria or symptomatic polycythaemia. Conclusions: Our study suggests that placental transfusion is not associated with hyperbilirubinemia requiring phototherapy or exchange transfusion.

Abstract

Objective: We aimed to demonstrate non-inferiority of delayed cord clamping (DCC) and cord milking (CM) in comparison to early cord clamping (ECC) in the incidence of hyperbilirubinemia requiring phototherapy. Material and methods: 467 of maternal-foetal dyads were screened for eligibility. 389 term infants, of breastfeeding, non-smoking mothers were randomized to receive ECC ( < 40 s), DCC (1–2 min) or CM (4 times towards the neonate). The primary outcome was defined as hyperbilirubinemia requiring phototherapy. Results: 307 patients were included in the analysis. CM did not increase the risk of phototherapy RR 11.27 95% CI (0.80; 2.04). Similar results were achieved when comparing DCC and ECC, RR 1.29 95% CI (0.82; 2.05). This was also true for CM vs DCC, RR 0.99 95% CI (0.64; 1.52). The prevalence of total serum bilirubin (TSB) at 24–48 hours was 10.8 mg/dL; 10.33 mg/dL and 11.39 in ECC, CM and DCC group respectively. Transcutaneous bilirubin (TcB) levels at 24–48 h were 7.58 mg/dL, 7.89 mg/dL and 7.60 mg/dL in the ECC, CM and DCC respectively. None of the neonates met exchange transfusion criteria or symptomatic polycythaemia. Conclusions: Our study suggests that placental transfusion is not associated with hyperbilirubinemia requiring phototherapy or exchange transfusion.

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Keywords

jaundice; hyperbilirubinemia; neonate; placental transfusion

About this article
Title

The risk of hyperbilirubinemia in term neonates after placental transfusion — a randomized-blinded controlled trial

Journal

Ginekologia Polska

Issue

Vol 91, No 10 (2020)

Article type

Research paper

Pages

613-619

Published online

2020-10-21

DOI

10.5603/GP.a2020.0096

Pubmed

33184830

Bibliographic record

Ginekol Pol 2020;91(10):613-619.

Keywords

jaundice
hyperbilirubinemia
neonate
placental transfusion

Authors

Joanna P. Seliga-Siwecka
Joanna Puskarz-Gasowska
Justyna Tolloczko

References (25)
  1. Wyllie J, Perlman JM, Kattwinkel J, et al. Neonatal Resuscitation Chapter Collaborators, Neonatal Resuscitation Chapter Collaborators, Neonatal Resuscitation Chapter Collaborators. Part 7: Neonatal Resuscitation: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations (Reprint). Pediatrics. 2015; 136 Suppl 2(16 Suppl 1): S120–S166.
  2. Prendiville WJ, Harding JE, Elbourne DR, et al. The Bristol third stage trial: active versus physiological management of third stage of labour. BMJ. 1988; 297(6659): 1295–1300.
  3. McDonald SJ, Middleton P, Dowswell T, et al. Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. Cochrane Database Syst Rev. 2008; 9(2): CD004074–397.
  4. Saigal S, O'Neill A, Surainder Y, et al. Placental transfusion and hyperbilirubinemia in the premature. Pediatrics. 1972; 49(3): 406–419.
  5. Hutton EK, Hassan ES. Late vs early clamping of the umbilical cord in full-term neonates: systematic review and meta-analysis of controlled trials. JAMA. 2007; 297(11): 1241–1252.
  6. Tarnow-Mordi W, Morris J, Kirby A, et al. Australian Placental Transfusion Study Collaborative Group. Delayed versus Immediate Cord Clamping in Preterm Infants. N Engl J Med. 2017; 377(25): 2445–2455.
  7. Fogarty M, Osborn DA, Askie L, et al. Delayed vs early umbilical cord clamping for preterm infants: a systematic review and meta-analysis. Am J Obstet Gynecol. 2018; 218(1): 1–18.
  8. Yang S, Duffy JY, Johnston R, et al. Association of a Delayed Cord-Clamping Protocol With Hyperbilirubinemia in Term Neonates. Obstet Gynecol. 2019; 133(4): 754–761.
  9. Linderkamp O, Nelle M, Kraus M, et al. The effect of early and late cord-clamping on blood viscosity and other hemorheological parameters in full-term neonates. Acta Paediatr. 1992; 81(10): 745–750.
  10. Yao ACL, Vuorenkoski J. Expiratory grunting in the late clamped normal neonate. Pediatrics. 1971; 48(6): 865–870.
  11. Rabe H, Jewison A, Alvarez RF, et al. Brighton Perinatal Study Group. Milking compared with delayed cord clamping to increase placental transfusion in preterm neonates: a randomized controlled trial. Obstet Gynecol. 2011; 117(2 Pt 1): 205–211.
  12. Brune T, Garritsen H, Witteler R, et al. Autologous placental blood transfusion for the therapy of anaemic neonates. Biol Neonate. 2002; 81(4): 236–243.
  13. Bhutani VK, Committee onF. Neonate, American Academy of P. Phototherapy to prevent severe neonatal hyperbilirubinemia in the neonate infant 35 or more weeks of gestation. Pediatrics. 2011; 128(4): e1046–52.
  14. Emhamed MO, van Rheenen P, Brabin BJ. The early effects of delayed cord clamping in term infants born to Libyan mothers. Trop Doct. 2004; 34(4): 218–222.
  15. American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics. 2004; 114(1): 297–316.
  16. Qian Y, Ying X, Wang P, et al. Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. Cochrane Database Syst Rev. 2008; 112(2): CD004074–178.
  17. Maisels MJ, Kring E. Transcutaneous bilirubin levels in the first 96 hours in a normal newborn population of > or = 35 weeks' gestation. Pediatrics. 2006; 117(4): 1169–1173.
  18. Gupta R, Ramji S. Effect of delayed cord clamping on iron stores in infants born to anemic mothers: a randomized controlled trial. Indian Pediatr. 2002; 39(2): 130–135.
  19. Grajeda R, Pérez-Escamilla R, Dewey KG. Delayed clamping of the umbilical cord improves hematologic status of Guatemalan infants at 2 mo of age. Am J Clin Nutr. 1997; 65(2): 425–431.
  20. Hutton EK, Hassan ES. Late vs early clamping of the umbilical cord in full-term neonates: systematic review and meta-analysis of controlled trials. JAMA. 2007; 297(11): 1241–1252.
  21. Rabe H, Jewison A, Alvarez RF, et al. Brighton Perinatal Study Group. Milking compared with delayed cord clamping to increase placental transfusion in preterm neonates: a randomized controlled trial. Obstet Gynecol. 2011; 117(2 Pt 1): 205–211.
  22. Keren R, Luan X, Friedman S, et al. A comparison of alternative risk-assessment strategies for predicting significant neonatal hyperbilirubinemia in term and near-term infants. Pediatrics. 2008; 121(1): e170–e179.
  23. Johnson L, Bhutani V. Guidelines for Management of the Jaundiced Term and Near-Term Infant. Clinics in Perinatology. 1998; 25(3): 555–574.
  24. Bhutani VK, Johnson LH, Keren R. Diagnosis and management of hyperbilirubinemia in the term neonate: for a safer first week. Pediatr Clin North Am. 2004; 51(4): 843–61, vii.
  25. van Rheenen P, Brabin BJ. Late umbilical cord-clamping as an intervention for reducing iron deficiency anaemia in term infants in developing and industrialised countries: a systematic review. Ann Trop Paediatr. 2004; 24(1): 3–16.

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