The Effects of Placental Transfusion on Placental Residual Blood Volume and 24 to 48‐hour Hemoglobin and Serum Bilirubin in Term Newborns: A Randomized Controlled Trial

摘要

Purpose To determine if newborns who receive a full placental transfusion at birth differ in placental residual blood volume (PRBV) and 24 to 48‐hour hemoglobin (Hb) and total serum bilirubin (TSB) levels compared to newborns who receive no placental transfusion. Research Question Will newborns who receive a full placental transfusion have less PRBV, a higher 24 to 48‐hour Hb, and no difference in peak TSB compared to newborns who receive no placental transfusion? Significance The usual maternity care practice in the United States is to immediately clamp the umbilical cord (immediate cord clamping [ICC]) at the time of birth. When ICC occurs, 20% to 40% of the fetal‐placental blood volume (containing iron‐rich red blood cells) is left behind in the placenta, potentially leading to lower iron stores in infancy. Methods A prospective randomized controlled trial was conducted. Seventy‐three healthy term pregnant women with singleton fetuses were enrolled. At birth, they were randomized to either ICC (20 seconds; n = 36) or delayed cord clamping (DCC) (≥5 minutes; n = 37) and then placed skin‐to‐skin. The primary endpoints were PRBV in mL/kg, Hb (g/dL), and peak TSB at 24 to 48 hours of age. Primary analyses were conducted by intention‐to‐treat and secondary analyses by actual treatment. Results Maternal and newborn demographics were not significantly different between groups. Mean (standard deviation [SD]) cord clamping time was 303 (121) seconds (DCC) versus 10 (6) (ICC) seconds ( P = .001). Eleven newborns received cord milking as a proxy for DCC at the time of cesarean birth or when resuscitation measures were indicated. There were 9 protocol violations. Newborns randomized to DCC left behind less PRBV (20.0 vs 30.8 mL/kg, P .001). At 24 to 48 hours of age, newborns exposed to DCC had significantly higher Hb levels (19.5 vs 17.7 g/dL, P = .002) without a difference in peak TSB levels (DCC = 8.5 vs ICC = 9.0 mg/dL, P = .45) compared to infants with ICC. Two newborns in each group had phototherapy. Discussion Newborns with ICC left behind more PRBV and had lower Hb levels at 24 to 48 hours. There was no difference between the groups on peak TSB levels or other indicators of hyperbilirubinemia. The results support the early hematological advantage of DCC while demonstrating no association with an increase in hyperbilirubinemia.