Intact cord resuscitation tied to effective physiological transition after birth in babies vs immediate cord clamping

A new trial found that resuscitation with an intact cord makes the postnatal physiological transition easier for preterm and term neonates than resuscitation after immediate cord clamping. The trial results were published in The Journal of Pediatrics. 

There is a high risk of morbidities like intraventricular hemorrhage or hypoxic-ischemic encephalopathy in preterm or term infants. Sometimes infants may need immediate resuscitation. But there is uncertainty about cord clamping and resuscitation. Hence researchers conducted an open-label, parallel-group, randomized controlled superiority trial in a tertiary care hospital in India to compare the effect of intact cord versus clamped cord resuscitation on the physiological transition of neonates receiving positive pressure ventilation (PPV) at birth. 

As per the Neonatal Resuscitation Program algorithm, neonates being born at ≥ 34 weeks of gestation after a complicated pregnancy or labor were randomized just before birth to receive resuscitation with either an intact cord or early cord clamping. They were grouped under the intact cord resuscitation or ICR group and the early cord clamping-resuscitation or ECR group. The intervention was done based on the need for PPV in the neonate at birth. The primary outcome was an 'expanded Apgar score' at 5 minutes after birth. 

Results: 

• Birth weight, gestation, and incidence of pregnancy complications were similar in the two study groups.
• The proportion of neonates who received PPV was lower in the ICR group (28.7% vs 36.5%).
• Among neonates who received PPV, the expanded Apgar score at 5 minutes was significantly higher in the ICR group.
• The ICR group showed higher expanded Apgar scores at 10 minutes, Apgar scores at 5- and 10-minutes, and oxygen saturation at 1, 5, and 10 minutes.

Thus, intact cord resuscitation shows an effective postnatal physiological transition in preterm and term neonates than the standard practice of resuscitation after immediate cord clamping. 

Further reading: Raina JS, Chawla D, Jain S, Khurana S, Sehgal A, Rani S. Resuscitation with intact versus clamped cord in late preterm and term neonates: A randomized controlled trial [published online ahead of print, 2022 Oct 17]. J Pediatr. 2022;S0022-3476(22)00898-8. doi:10.1016/j.jpeds.2022.08.061