Special Issue "Neonatal Resuscitation with Placental Circulation Intact"

A special issue of Children (ISSN 2227-9067).

Deadline for manuscript submissions: 10 January 2022.

Special Issue Editors

Dr. Simone Pratesi
E-Mail Website
Guest Editor
Università degli Studi di Firenze, 50121 Firenze, Italy
Interests: neonatal transition; neonatal resuscitation; neonatal jaundice; phototherapy for neonatal hyperbilirubinemia; near-infrared spectroscopy
Dr. David Hutchon
E-Mail Website
Guest Editor
Memorial Hospital, Darlington, DL3 6HX, UK
Interests: equipment design; process and training to achieve motherside neonatal resuscitation with an intact cord
Dr. Anup Katheria
E-Mail Website
Guest Editor
Sharp Mary Birch Hospital for Women & Newborns, San Diego, CA 92123, USA
Interests: neonatal transition; neonatal resuscitation; near-infrared spectroscopy

Special Issue Information

Dear Colleagues,

Neonatal transitional physiology should include a delay in cord clamping until after the newborn is breathing: this is easy to perform in a healthy term newborn but not in a sick or preterm newborn. A delayed cord clamping of 30 seconds reduces the hospital mortality of preterm newborns. Very limited data are available on delayed cord clamping in term newborns who require neonatal resuscitation at birth. Resuscitation with an intact cord has been feasible and safe, both in term and preterm newborns, and could be the best way to stabilize a newborn in the delivery room.

Immediate cord clamping still represents the standard care in preterm and sick newborns worldwide. To promote a different, more physiological approach to newborns in need of assistance at birth, neonatologists should move close to the delivering mother, so to evaluate the tone, heart rate, and efforts of the newborn to breathe, and start at least the initial steps of stabilization (above all breathing tactile stimulation) before the cord is clamped. Recent studies have demonstrated that it is safely feasible, using special equipped and a movable trolley. However, these devices still need technological improvements and are too expensive to permit a rapid spread of this approach in delivery room care protocols.

The goal of this research topic is to promote the spread of a new way of resuscitating newborns in the delivery room: to perform exactly the same neonatal resuscitation procedures but with a different landscape, that is at motherside with an intact cord. Contributors are invited to send original research articles, clinical trial articles, study protocol, brief research, or case report articles and technology and code articles, addressing themes such as the following:

  • Delayed cord clamping, longer than 1 minute after newborn’s breathing, in preterm babies
  • Neonatal resuscitation/assistance with an intact cord in preterm newborns
  • Neonatal resuscitation with an intact cord in asphyxiated term newborns
  • Neonatal resuscitation with an intact cord in congenital fetal anomalies (hydrops fetalis, diaphragmatic hernia, etc.)
  • Technological advances (trolley, heating system, ventilation system, etc.) to promote neonatal assistance with an intact cord
  • High fidelity simulation to promote multi-professional neonatal assistance with an intact cord
  • Physiological (hemodynamic and respiratory) neonatal adaptation during an intact cord transition (both animal or human studies)

Dr. Simone Pratesi
Dr. David Hutchon
Dr. Anup Katheria
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All papers will be peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Children is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Delayed cord clamping;
  • Immediate cord clamping;
  • Neonatal resuscitation at motherside;
  • Neonatal assistance with an intact cord;
  • Physiologically based cord clamping

Published Papers (8 papers)

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Editorial

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Editorial
How to Provide Motherside Neonatal Resuscitation with Intact Placental Circulation?
Children 2021, 8(4), 291; https://doi.org/10.3390/children8040291 - 08 Apr 2021
Cited by 2 | Viewed by 449
Abstract
Immediate clamping and cutting of the umbilical cord have been associated with death and/or neurodisability [...] Full article
(This article belongs to the Special Issue Neonatal Resuscitation with Placental Circulation Intact)
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Research

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Article
The BabySaver: Design of a New Device for Neonatal Resuscitation at Birth with Intact Placental Circulation
Children 2021, 8(6), 526; https://doi.org/10.3390/children8060526 - 21 Jun 2021
Viewed by 941
Abstract
The initial bedside care of premature babies with an intact cord has been shown to reduce mortality; there is evidence that resuscitation of term babies with an intact cord may also improve outcomes. This process has been facilitated by the development of bedside [...] Read more.
The initial bedside care of premature babies with an intact cord has been shown to reduce mortality; there is evidence that resuscitation of term babies with an intact cord may also improve outcomes. This process has been facilitated by the development of bedside resuscitation surfaces. These new devices are unaffordable, however, in most of sub-Saharan Africa, where 42% of the world’s 2.4 million annual newborn deaths occur. This paper describes the rationale and design of BabySaver, an innovative low-cost mobile resuscitation unit, which was developed iteratively over five years in a collaboration between the Sanyu Africa Research Institute (SAfRI) in Uganda and the University of Liverpool in the UK. The final BabySaver design comprises two compartments; a tray to provide a firm resuscitation surface, and a base to store resuscitation equipment. The design was formed while considering contextual factors, using the views of individual women from the community served by the local hospitals, medical staff, and skilled birth attendants in both Uganda and the UK. Full article
(This article belongs to the Special Issue Neonatal Resuscitation with Placental Circulation Intact)
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Article
Sustained Inflation Reduces Pulmonary Blood Flow during Resuscitation with an Intact Cord
Children 2021, 8(5), 353; https://doi.org/10.3390/children8050353 - 29 Apr 2021
Viewed by 499
Abstract
The optimal timing of cord clamping in asphyxia is not known. Our aims were to determine the effect of ventilation (sustained inflation–SI vs. positive pressure ventilation–V) with early (ECC) or delayed cord clamping (DCC) in asphyxiated near-term lambs. We hypothesized that SI with [...] Read more.
The optimal timing of cord clamping in asphyxia is not known. Our aims were to determine the effect of ventilation (sustained inflation–SI vs. positive pressure ventilation–V) with early (ECC) or delayed cord clamping (DCC) in asphyxiated near-term lambs. We hypothesized that SI with DCC improves gas exchange and hemodynamics in near-term lambs with asphyxial bradycardia. A total of 28 lambs were asphyxiated to a mean blood pressure of 22 mmHg. Lambs were randomized based on the timing of cord clamping (ECC—immediate, DCC—60 s) and mode of initial ventilation into five groups: ECC + V, ECC + SI, DCC, DCC + V and DCC + SI. The magnitude of placental transfusion was assessed using biotinylated RBC. Though an asphyxial bradycardia model, 2–3 lambs in each group were arrested. There was no difference in primary outcomes, the time to reach baseline carotid blood flow (CBF), HR ≥ 100 bpm or MBP ≥ 40 mmHg. SI reduced pulmonary (PBF) and umbilical venous (UV) blood flow without affecting CBF or umbilical arterial blood flow. A significant reduction in PBF with SI persisted for a few minutes after birth. In our model of perinatal asphyxia, an initial SI breath increased airway pressure, and reduced PBF and UV return with an intact cord. Further clinical studies evaluating the timing of cord clamping and ventilation strategy in asphyxiated infants are warranted. Full article
(This article belongs to the Special Issue Neonatal Resuscitation with Placental Circulation Intact)
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Article
Changes in Umbilico–Placental Circulation during Prolonged Intact Cord Resuscitation in a Lamb Model
Children 2021, 8(5), 337; https://doi.org/10.3390/children8050337 - 26 Apr 2021
Viewed by 340
Abstract
Some previous studies reported a benefit to cardiopulmonary transition at birth when starting resuscitation maneuvers while the cord was still intact for a short period of time. However, the best timing for umbilical cord clamping in this condition is unknown. The aim of [...] Read more.
Some previous studies reported a benefit to cardiopulmonary transition at birth when starting resuscitation maneuvers while the cord was still intact for a short period of time. However, the best timing for umbilical cord clamping in this condition is unknown. The aim of this study was to explore the duration of effective umbilico–placental circulation able to promote cardiorespiratory adaptation at birth during intact cord resuscitation. Umbilico–placental blood flow and vascular resistances were measured in an experimental neonatal lamb model. After a C-section delivery, the lambs were resuscitated ventilated for 1 h while the cord was intact. The maximum and mean umbilico–placental blood flow were respectively 230 ± 75 and 160 ± 12 mL·min−1 during the 1 h course of the experiment. However, umbilico–placental blood flow decreased and vascular resistance increased significantly 40 min after birth (p < 0.05). These results suggest that significant cardiorespiratory support can be provided by sustained placental circulation for at least 1 h during intact cord resuscitation. Full article
(This article belongs to the Special Issue Neonatal Resuscitation with Placental Circulation Intact)
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Article
The Assisted Breathing before Cord Clamping (ABC) Study Protocol
Children 2021, 8(5), 336; https://doi.org/10.3390/children8050336 - 26 Apr 2021
Viewed by 334
Abstract
Major physiologic changes occur during the transition after birth. For preterm infants, current understanding favours allowing the initial changes to occur prior to cord clamping. Amongst other improved outcomes, systematic reviews have indicated a significant reduction in neonatal blood transfusions following delayed cord [...] Read more.
Major physiologic changes occur during the transition after birth. For preterm infants, current understanding favours allowing the initial changes to occur prior to cord clamping. Amongst other improved outcomes, systematic reviews have indicated a significant reduction in neonatal blood transfusions following delayed cord clamping. This may be due to a placental transfusion, facilitated by the onset of respiration. If breathing is compromised, placental transfusion may be reduced, resulting in a greater red cell transfusion rate. We designed a randomised trial to investigate whether assisting respiration in this high-risk group of babies would decrease blood transfusion and improve outcomes. The Assisted Breathing before Cord Clamping (ABC) study is a single-centre randomised controlled trial. Preterm infants < 31 weeks that have not established regular breathing before 15 s are randomised to a standard or intervention group. The intervention is intermittent positive pressure ventilation via T piece for 30 s, whilst standard management consists of 30 s of positioning and gentle stimulation. The cord is clamped at 50 s in both groups. The primary outcome is the proportion of infants in each group receiving blood transfusion during the neonatal admission. Secondary outcomes include requirement for resuscitation, the assessment of circulatory status and neonatal outcomes. Full article
(This article belongs to the Special Issue Neonatal Resuscitation with Placental Circulation Intact)
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Article
Resuscitation with an Intact Cord Enhances Pulmonary Vasodilation and Ventilation with Reduction in Systemic Oxygen Exposure and Oxygen Load in an Asphyxiated Preterm Ovine Model
Children 2021, 8(4), 307; https://doi.org/10.3390/children8040307 - 17 Apr 2021
Viewed by 564
Abstract
(1) Background: Optimal initial oxygen (O2) concentration in preterm neonates is controversial. Our objectives were to compare the effect of delayed cord clamping with ventilation (DCCV) to early cord clamping followed by ventilation (ECCV) on O2 exposure, gas exchange, and [...] Read more.
(1) Background: Optimal initial oxygen (O2) concentration in preterm neonates is controversial. Our objectives were to compare the effect of delayed cord clamping with ventilation (DCCV) to early cord clamping followed by ventilation (ECCV) on O2 exposure, gas exchange, and hemodynamics in an asphyxiated preterm ovine model. (2) Methods: Asphyxiated preterm lambs (127–128 d) with heart rate <90 bpm were randomly assigned to DCCV or ECCV. In DCCV, positive pressure ventilation (PPV) was initiated with 30–60% O2 and titrated based on preductal saturations (SpO2) with an intact cord for 5 min, followed by clamping. In ECCV, the cord was clamped, and PPV was initiated. (3) Results: Fifteen asphyxiated preterm lambs were randomized to DCCV (N = 7) or ECCV (N = 8). The inspired O2 (40 ± 20% vs. 60 ± 20%, p < 0.05) and oxygen load (520 (IQR 414–530) vs. 775 (IQR 623–868), p-0.03) in the DCCV group were significantly lower than ECCV. Arterial oxygenation and carbon dioxide (PaCO2) levels were significantly lower and peak pulmonary blood flow was higher with DCCV. (4) Conclusion: In asphyxiated preterm lambs, resuscitation with an intact cord decreased O2 exposure load improved ventilation with an increase in peak pulmonary blood flow in the first 5 min. Full article
(This article belongs to the Special Issue Neonatal Resuscitation with Placental Circulation Intact)
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Other

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Brief Report
A Feasibility Study of a Novel Delayed Cord Clamping Cart
Children 2021, 8(5), 357; https://doi.org/10.3390/children8050357 - 29 Apr 2021
Viewed by 755
Abstract
Delaying umbilical cord clamping (DCC) for 1 min or longer following a neonate’s birth has now been recommended for preterm and term newborns by multiple professional organizations. DCC has been shown to decrease rates of iron deficiency anemia, intraventricular hemorrhage (IVH), necrotizing enterocolitis [...] Read more.
Delaying umbilical cord clamping (DCC) for 1 min or longer following a neonate’s birth has now been recommended for preterm and term newborns by multiple professional organizations. DCC has been shown to decrease rates of iron deficiency anemia, intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), and blood transfusion. Despite these benefits, clinicians typically cut the umbilical cord without delay in neonates requiring resuscitation and move them to a radiant warmer for further care; this effectively prevents these patients from receiving any benefits from DCC. This study evaluated the feasibility of a delayed cord clamping cart (DCCC) in low-risk neonates born via Cesarean section (CS). The DCCC is a small, sterile cart designed to facilitate neonatal resuscitation while the umbilical cord remains intact. The cart is cantilevered over the operating room (OR) table during a CS, allowing the patient to be placed onto it immediately after birth. For this study, a sample of 20 low-risk CS cases were chosen from the non-emergency Labor and Delivery surgical case list. The DCCC was utilized for 1 min of DCC in all neonates. The data collected included direct observation by research team members, recorded debriefings and surveys of clinicians as well as surveys of patients. Forty-four care team members participated in written surveys; of these, 16 (36%) were very satisfied, 12 (27%) satisfied, 13 (30%) neutral, and 3 (7%) were somewhat dissatisfied with use of the DCCC in the OR. Feedback was collected from all 20 patients, with 18 (90%) reporting that they felt safe with the device in use. This study provides support that utilizing a DCCC can facilitate DCC with an intact umbilical cord. Full article
(This article belongs to the Special Issue Neonatal Resuscitation with Placental Circulation Intact)
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Study Protocol
Efficacy of Intact Cord Resuscitation Compared to Immediate Cord Clamping on Cardiorespiratory Adaptation at Birth in Infants with Isolated Congenital Diaphragmatic Hernia (CHIC)
Children 2021, 8(5), 339; https://doi.org/10.3390/children8050339 - 26 Apr 2021
Viewed by 407
Abstract
Resuscitation at birth of infants with Congenital Diaphragmatic Hernia (CDH) remains highly challenging because of severe failure of cardiorespiratory adaptation at birth. Usually, the umbilical cord is clamped immediately after birth. Delaying cord clamping while the resuscitation maneuvers are started may: (1) facilitate [...] Read more.
Resuscitation at birth of infants with Congenital Diaphragmatic Hernia (CDH) remains highly challenging because of severe failure of cardiorespiratory adaptation at birth. Usually, the umbilical cord is clamped immediately after birth. Delaying cord clamping while the resuscitation maneuvers are started may: (1) facilitate blood transfer from placenta to baby to augment circulatory blood volume; (2) avoid loss of venous return and decrease in left ventricle filling caused by immediate cord clamping; (3) prevent initial hypoxemia because of sustained uteroplacental gas exchange after birth when the cord is intact. The aim of this trial is to evaluate the efficacy of intact cord resuscitation compared to immediate cord clamping on cardiorespiratory adaptation at birth in infants with isolated CDH. The Congenital Hernia Intact Cord (CHIC) trial is a prospective multicenter open-label randomized controlled trial in two balanced parallel groups. Participants are randomized either immediate cord clamping (the cord will be clamped within the first 15 s after birth) or to intact cord resuscitation group (umbilical cord will be kept intact during the first part of the resuscitation). The primary end-point is the number of infants with APGAR score <4 at 1 min or <7 at 5 min. One hundred eighty participants are expected for this trial. To our knowledge, CHIC is the first study randomized controlled trial evaluating intact cord resuscitation on newborn infant with congenital diaphragmatic hernia. Better cardiorespiratory adaptation is expected when the resuscitation maneuvers are started while the cord is still connected to the placenta. Full article
(This article belongs to the Special Issue Neonatal Resuscitation with Placental Circulation Intact)
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