A Comparative Study of Placental Transfusion in Very Preterm Neonates
Journal Title: Scholars Journal of Applied Medical Sciences - Year 2018, Vol 6, Issue 2
Abstract
Abstract: We aimed to compare the effect of Umbilical Cord Milking (UCM) and Early Cord Clamping (ECC) on haematocrit levels at 6weeks in very preterm neonates (28+1weeks-31+6weeks). Ours was a prospective comparative study comparing the haematological parameters and serum bilirubin values in early cord clamping (ECC) and Umbilical cord milking (UCM) and included 102 very preterm neonates over a period of 18months. Of the 102 very preterm neonates included in the study, 51 each were studied in early cord clamping and Umbilical Cord Milking (UCM). 30(29.4%) and 72(70.6%) neonates were in 28-29+6weeks and 30-31+6weeks respectively. 13.6% in ECC and 25.5% in UCM had risk factor of maternal anemia. In all 7 neonates with antepartum haemorrhage, ECC was the intervention done. Mothers with risk factor of gestational diabetes mellitus (GDM) were noted in 25.4% in ECC and 31.3% in UCM. Maternal infection was noted in 13.7% of the neonates in each group. 14.7% and 73.5% of very preterm neonates received one dose and two doses of antenatal steroid therapy respectively. Umbilical cord milking was done in 58.8% neonates delivered by normal vaginal delivery. ECC was the major intervention done in neonates with perinatal asphyxia. In neonates who required CPAP and mechanical ventilation, UCM was done in 38.2% and 2.4% neonates respectively. 27 neonates had Apgar score 1-4 and in 25 neonates early cord clamping was done. Male to Female ratio in UCM and ECC was 0.75:1 and 1.3:1. Mean haemoglobin and haematocrit at day 3 was high in neonates with UCM compared to ECC (16.57±2.34 vs. 15.71±2.17) and (50.34±7.07 vs. 46.21±6.55). Serum bilirubin levels were higher in UCM requiring phototherapy. Requirement of packed red cell transfusion (PRBC) in UCM was less compared to ECC (11.8% vs. 29.4%). Haemoglobin and haematocrit levels at 6 weeks were also high in UCM (12.16±1.85 vs. 10.47±1.71) and (36.71±6.1 vs. 31.57±5.10). Incidence of sepsis was less in UCM (13.7% vs. 19.6%). Haematocrit and haemoglobin at 6weeks were significantly higher and the incidences of anaemia lower in the UCM group. And the need for PRBC transfusion was found to be significantly less in UCM group. Need for mechanical ventilation and oxygen requirement were also significantly less for UCM group. Serum bilirubin at day 3 and requirement of phototherapy were significantly more in the UCM group compared to ECC even though none of the babies required exchange transfusion. No incidence of polycythemia was found in either group. There was no significant difference in incidence of sepsis in either group.
Authors and Affiliations
V. C Manoj, Anirudh Reddy P, Sudha A, Dhanya Unnikrishnan
Keywords
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