Arch Dis Child Fetal Neonatal Ed. 2019 Aug 28. pii: fetalneonatal-2019-317477. doi: 10.1136/archdischild-2019-317477. [Epub ahead of print]
https://www.ncbi.nlm.nih.gov/pubmed/31462406
Initiating resuscitation before umbilical cord clamping in infants with congenital diaphragmatic hernia: a pilot feasibility trial.
Foglia EE1, Ades A2, Hedrick HL3, Rintoul N2, Munson DA2, Moldenhauer J3, Gebb J3, Serletti B3, Chaudhary A2, Weinberg DD2, Napolitano N4, Fraga MV2, Ratcliffe SJ5.
Author information
1Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA foglia@email.chop.edu.2Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.3Department of Surgery, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.4Department of Nursing and Respiratory Care, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.5Department of Biostatistics, University of Virginia, Charlottesville, Virginia, USA.
Abstract
BACKGROUND:
Infants with congenital diaphragmatic hernia (CDH) often experience hypoxaemia with acidosis immediately after birth. The traditional approach in the delivery room is immediate cord clamping followed by intubation. Initiating resuscitation prior to umbilical cord clamping (UCC) may support this transition.
OBJECTIVES:
To establish the safety and feasibility of intubation and ventilation prior to UCC for infants with CDH. To compare short-term outcomes between trial participants and matched controls treated with immediate cord clamping before intubation and ventilation.
DESIGN:
Single-arm, single-site trial of infants with CDH and gestational age ≥36 weeks. Infants were placed on a trolley immediately after birth and underwent intubation and ventilation, with UCC performed after qualitative CO2 detection. The primary feasibility endpoint was successful intubation prior to UCC. Prespecified safety and physiological outcomes were compared with historical controls matched for prognostic variables using standard bivariate tests.
RESULTS:
Of 20 enrolled infants, all were placed on the trolley, and 17 (85%) infants were intubated before UCC. The first haemoglobin and mean blood pressure at 1 hour of life were significantly higher in trial participants than controls. There were no significant differences between groups for subsequent blood pressure values, vasoactive medications, inhaled nitric oxide or extracorporeal membrane oxygenation. Blood gas and oxygenation index values did not differ between groups at any point.
CONCLUSIONS:
Intubation and ventilation prior to UCC is safe and feasible among infants with CDH. The impact of this approach on clinically relevant outcomes deserves investigation in a randomised trial.
© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.
KEYWORDS:
neonatology; procedures; resuscitationPMID: 31462406 DOI: 10.1136/archdischild-2019-317477
