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Cardiovascular Instability in the Preterm Infant

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Front. Pediatr. | doi: 10.3389/fped.2018.00039

Placental Transfusion and Cardiovascular Instability in the Preterm Infant

 Zbynek Stranak1, 2, Simona Feyereislová1, 2,  Peter Korček1, 2* and  Eugene Dempsey3
  • 1Third Faculty of Medicine, Charles University, Czechia
  • 2Institute for the Care of Mother and Child, Czechia
  • 3Cork University Maternity Hospital, Ireland

Postnatal adaptation in preterm newborn comprises complex physiological processes that involve significant changes in the circulatory and respiratory system. Increasing haemoglobin level and blood volume following placental transfusion may be of importance in enhancing arterial oxygen content, increasing cardiac output and improving oxygen delivery.

The European consensus on resuscitation of preterm infants recommends delayed cord clamping (DCC) for at least 60 seconds to promote placenta-fetal transfusion in uncompromised neonates. Recently published meta-analyses suggest that DCC is associated with fewer infants requiring transfusions for anaemia, a lower incidence of intraventricular haemorrhage (IVH) and lower risk for necrotizing enterocolitis.

Umbilical cord milking (UCM) has the potential to avoid some disadvantages associated with DCC including the increased risk of hypothermia or delay in commencing manual ventilation. UCM represents an active form of blood transfer from placenta to neonate and may have some advantages over DCC. Moreover, both methods are associated with improvement in haemodynamic parameters and blood pressure within first hours after delivery compared to immediate cord clamping.

Placental transfusion appears to be beneficial for the preterm uncompromised infant. Further studies are needed to evaluate simultaneous placental transfusion with resuscitation of deteriorating neonates. It would be of great interest for future research to investigate advantages of this approach further and to assess its impact on neonatal outcomes, particularly in extremely preterm infants.

Keywords: Transition, Placental transfusion, Hypotension, neonatal outcome, vlbw

Received: 28 Nov 2017; Accepted: 09 Feb 2018.

Edited by:

Po-Yin Cheung, University of Alberta, Canada

Reviewed by:

Karel Allegaert, University Hospitals Leuven, Belgium
Pascal M. Lavoie, BC Children's Hospital Research Institute, Canada
Anup C. Katheria, Sharp Mary Birch Hospital for Women & Newborns, United States  

Copyright: © 2018 Stranak, Feyereislová, Korček and Dempsey. 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 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.

* Correspondence: Dr. Peter Korček, Third Faculty of Medicine, Charles University, Prague, Czechia, Peterkorcek.upmd@gmail.com