Rohingya mother Hala*, 35, sits with 25 day-old baby Rama* in her makeshift tent in Cox's Bazar, Bangladesh. In her own words: “They burned our houses leaving none. My house and everything inside was burnt. My cattle were taken away” “We walked for three days. I was worried my baby would be born on the way. We reached the border on the fourth day. We crossed on the fifth day. We had no food and no sip of water. We couldn’t walk any further. Our legs swelled.” “We came here to save our lives.” “After crossing we received food. After eating we felt stronger but we couldn’t get up. Our children were sick.” ‘On the sixth day, we found the clinic and built our tent.” “It was the eighth month of the pregnancy and the pains started. We went to the clinic where the child was delivered.” ‘The doctors gave us nice care and treatment. They also treated my two children who fell ill because of the journey.” “They come and check the baby weekly. Two weeks from birth, the baby got pneumonia. We had no blanket and the baby was cold. I was scared the baby would die. The nurses saw my baby and gave treatment. We are both fully recovered.” “I am breast-feeding. The baby can sleep and eat properly. I am now able to sleep properly. I feel very happy.” “I want my child to have an education.”
Background
Experiments have shown improved cardiovascular stability in lambs if umbilical cord clamping is postponed until positive pressure ventilation is started. Studies on intact cord resuscitation on human term infants are sparse. The purpose of this study was to evaluate differences in clinical outcomes in non-breathing infants between groups, one where resuscitation is initiated with an intact umbilical cord (intervention group) and one group where cord clamping occurred prior to resuscitation (control group).
Methods
Randomized controlled trial, inclusion period April to August 2016 performed at a tertiary hospital in Kathmandu, Nepal. Late preterm and term infants born vaginally, non-breathing and in need of resuscitation according to the ‘Helping Babies Breathe’ algorithm were randomized to intact cord resuscitation or early cord clamping before resuscitation. Main outcome measures were saturation by pulse oximetry (SpO2), heart rate and Apgar at 1, 5 and 10 minutes after birth.
Results
At 10 minutes after birth, SpO2 (SD) was significantly higher in the intact cord group compared to the early cord clamping group, 90.4 (8.1) vs 85.4 (2.7) %, P < .001). In the intact cord group, 57 (44%) had SpO2 < 90% after 10 minutes, compared to 93 (100%) in the early cord clamping group, P < 0.001. SpO2 was also significantly higher in the intervention (intact cord) group at one and five minutes after birth. Heart rate was lower in the intervention (intact cord) group at one and five minutes and slightly higher at ten minutes, all significant findings. Apgar score was significantly higher at one, five and ten minutes. At 5 minutes, 23 (17%) had Apgar score < 7 in the intervention (intact cord) group compared to 26 (27%) in the early cord clamping group, P < .07. Newborn infants in the intervention (intact cord) group started to breathe and establish regular breathing earlier than in the early cord clamping group.
Conclusions
This study provides new and important information on the effects of resuscitation with an intact umbilical cord. The findings of improved SpO2 and higher Apgar score, and the absence of negative consequences encourages further studies with longer follow-up.