Eur J Pediatr. 2025 Nov 9;184(12):741. doi: 10.1007/s00431-025-06594-8.
ABSTRACT
Deferred cord clamping (DCC) enhances placental transfusion, yet its feasibility in extremely preterm infants requiring resuscitation remains uncertain. Intact cord resuscitation (ICR) may allow simultaneous placental transfusion and stabilization. This study evaluated the feasibility and short-term outcomes of ICR in infants born at 230/7 to 256/7 weeks of gestation. This single-center case-series study compared two consecutive two-year periods before and after the introduction of ICR (September 2023) in extremely preterm infants requiring delivery room resuscitation. Infants born during the earlier period underwent early cord clamping (ECC). Specialized trolleys were not available; instead, stabilization was performed in a sterile polyethylene bag placed on the mother’s abdomen. The primary outcome was survival at day 7. Secondary outcomes included admission vital signs, laboratory parameters, early morbidities, and transfusion requirements. Twenty-two infants were analyzed (12 ECC, 10 ICR). Baseline characteristics were similar. Apgar scores at 5 and 10 min were higher in ICR (p = 0.02 and p < 0.001). On neonatal intensive care unit admission, mean arterial pressure and hemoglobin levels were significantly higher in ICR (respectively, p < 0.001 and 0.04). Red blood cell transfusion and inotrope use were more frequent in ECC, though not statistically significant. The incidence of any grade intraventricular hemorrhage (IVH) and grade ≥ 2 IVH did not differ. Early mortality occurred in 6 ECC infants (50%), but in none of the ICR infants (p = 0.04).
CONCLUSION: In this case-series, ICR was feasible without specialized equipment in extremely preterm infants and was not associated with adverse outcomes. The procedure appeared to support early hemodynamic stabilization and short-term survival, providing preliminary observations that warrant confirmation in larger prospective studies.
WHAT IS KNOWN: • ICR was shown to be feasible and safe in extremely preterm infants born at 23-25 weeks of gestation, even without specialized resuscitation trolleys. • Compared with early cord clamping, ICR was associated with higher Apgar scores, improved hemodynamic stability, higher hemoglobin levels, and enhanced early survival.
WHAT IS NEW: • Deferred cord clamping (DCC) increases blood volume, hemoglobin, reduces transfusion needs, and lowers intraventricular hemorrhage (IVH) risk in neonates. • Intact cord resuscitation (ICR) has been proposed to combine placental transfusion with timely stabilization, though its feasibility in this high-risk group is still debated.
PMID:41206833 | DOI:10.1007/s00431-025-06594-8
