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Using Neohelp™ during delayed cord clamping 

Posted by   on 30-August-2017 
Using Neohelp™ during delayed cord clamping

The benefits of delayed cord clamping (DCC) in preterm babies have been long debated. On delivery, most preterm babies are in reasonable condition and are only in need of assisted transition, not resuscitation

Neohelp™ and its role in delayed cord clamping

 

Delayed cord clamping in preterm babies

The benefits of delayed cord clamping (DCC) in preterm babies have been long debated. On delivery, most preterm babies are in reasonable condition and are only in need of assisted transition, not resuscitation.[1]Providing that this is the case and that the baby can be kept warm, the Resuscitation Council UK (RCUK) recommends DCC for at least 60 seconds whilst breathing is established.[2]

Recent studies have demonstrated that DCC can improve cardiovascular stability in the key postnatal period, and is associated with a reduction in the requirement for blood transfusion3.  Provision of DCC has been shown to reduce the relative risk of intraventricular haemorrhage by 41% (RR 0.59, 95% CI 0.41 to 0.85) and necrotising enterocolitis by 38% (RR 0.62, 95% CI 0.43 to 0.90)[3]. However, performing DCC requires an environment that is warm; and for the significant proportion of babies delivered by operative delivery (caesarean section); this would also need to be sterile. 

 

Importance of providing thermal care

Thin skin, reduced subcutaneous fat, poor vasomotor control and an increased body surface to mass ratio, can significantly increase the risk of heat loss and subsequent hypothermia to a preterm baby. For instance, for every 1˚C decrease below 36.5˚C, the risk of sepsis in preterm babies is increased by 11%, whilst the risk of mortality is increased by 28%[4]. To put this in perspective, in the first 10-20 minutes, without any skin protection, temperatures can fall by 2-4˚C[5], with 50% of heat loss escaping from the baby’s head alone[6]. Even brief exposure to the effects of hypothermia has been associated with neonatal morbidity; impaired surfactant synthesis, impaired surfactant spreading within the lungs, pulmonary hypertension, hypoxia and coagulation defects. Acidosis and hypoxia further inhibits surfactant production[7],[8].

For a preterm infant delivered by c-section, the baby must first be placed in a warm and sterile environment, providing thermal care and skin protection.  Vygon (UK) Ltd has recently launched a sterile neonatal heat loss prevention suit called Neohelp™. This suit helps to prevent heat loss through its double layer of soft, clear polyethylene, integrated hood and hermetic VELCRO® seal, whilst DCC and Golden Hour Care take place.[9],[10]

 

The full article can be viewed via the following link:

 

http://www.infantgrapevine.co.uk/viewer/grapevine/121/flipviewerxpress.html

 



[1] O’Donnell CPF, Stenson BJ. Respiratory strategies for preterm infants.SeminFetal Neonatal Med 2008;13:401-9

[2]Resuscitation Council UK (RCUK).Newborn Life Support- National Resuscitation Guidelines, 2015.

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[3]Rabe H, Diaz-Rosello JL, Dudley L, Dowswell T.Early cord clamping versus delayed cord clamping or cord milking for preterm babies. Cochrane Database Syst Rev 2012;15 CD003248

[4] WWMV, Mori R. Interventions to prevent hypothermia at birth in preterm and/ or low birth weight infants. RHL

[5]World Health Organisation (WHO). Thermal protection of the newborn: practical guide, 1997.

[6] R. Bissinger and D. Annibale. Thermoregulation in very low-birth- weight infants during Golden Hour results and Implications. Advances in neonatal care. 2010.

[7]Gluck L, Kulovich MV, Eidelman AI, et al. Biochemical development of surface activity in mammalian lung. iv. Pulmonary leicthinb synthesis in the human foetus and newbornetiology of the respiratory distress syndrome. Pediatr Res 1972; 6:81-99.

[8]Merritt TA, Farrell PM. Diminished pulmonary lecithin synthesis in acidosis: Experimental findings as related to the respiratory distress syndrome. Paediatrics 1976;57:32-40.

[9]Rabe H, Diaz-Rossell JL, Duley L, Dowswell T. Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes. Cochrane Database Syst Rev 2012;8 CD003248

[10]Backes CH, Rivera BK, Haque U, et al. Placental transfusion strategies in very preterm neonates; a systematic review and metaanalysis. ObstetGynecol2014; 124:47-56

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