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Badurdeen S, Blank DA, Hoq M, Wong FY, Roberts CT, Hooper SB, Polglase GR, Davis PG. Blood pressure and cerebral oxygenation with physiologically-based cord clamping: sub-study of the BabyDUCC trial. Pediatr Res 2024; 96:124-131. [PMID: 38671085 PMCID: PMC11257956 DOI: 10.1038/s41390-024-03131-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 12/30/2023] [Accepted: 03/01/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Cord-clamping strategies may modify blood pressure (BP) and cerebral tissue oxygen saturation (rStO2) immediately after birth. METHODS We conducted a sub-study nested within the Baby-Directed Umbilical Cord-Clamping trial. Infants ≥32+0 weeks' gestation assessed as requiring resuscitation were randomly allocated to either physiologically-based cord clamping (PBCC), where resuscitation commenced prior to umbilical cord clamping, or standard care where cord clamping occurred early (ECC). In this single-site sub-study, we obtained additional measurements of pre-ductal BP and rStO2. In a separate observational arm, non-randomised vigorous infants received 2 min of deferred cord clamping (DCC) and contributed data for reference percentiles. RESULTS Among 161 included infants, n = 55 were randomly allocated to PBCC (n = 30) or ECC (n = 25). The mean (SD) BP at 3-4 min after birth (primary outcome) in the PBCC group was 64 (10) mmHg compared to 62 (10) mmHg in the ECC group, mean difference 2 mmHg (95% confidence interval -3-8 mmHg, p = 0.42). BP and rStO2 were similar across both randomised arms and the observational arm (n = 106). CONCLUSION We found no difference in BP or rStO2 with the different cord clamping strategies. We report reference ranges for BP and rStO2 for late-preterm and full-term infants receiving DCC. IMPACT Among late-preterm and full-term infants receiving varying levels of resuscitation, blood pressure (BP, at 3-4 minutes and 6 min) and cerebral tissue oxygen saturation (rStO2) are not influenced by timing of cord clamping in relation to establishment of ventilation. Infants in this study did not require advanced resuscitation, where cord clamping strategies may yet influence BP and rStO2. The reference ranges for BP and rStO2 represent the first, to our knowledge, for vigorous late-preterm and full-term infants receiving deferred cord clamping. rStO2 > 90% (~90th percentile) may be used to define cerebral hyperoxia, for instance when studying oxygen supplementation after birth.
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Affiliation(s)
- Shiraz Badurdeen
- Department of Obstetrics, Gynaecology, and Newborn Health, The University of Melbourne, Parkville, VIC, 3052, Australia.
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, VIC, 3052, Australia.
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC, 3168, Australia.
- Department of Paediatrics, Mercy Hospital for Women, Heidelberg, VIC, 3084, Australia.
| | - Douglas A Blank
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC, 3168, Australia
- Monash Newborn, Monash Children's Hospital, Clayton, VIC, 3168, Australia
- Department of Paediatrics, Monash University, Clayton, VIC, 3168, Australia
| | - Monsurul Hoq
- Clinical Epidemiology and Biostatistics Unit and Clinical Sciences Research, Murdoch Children's Research Institute, Melbourne, VIC, 3052, Australia
| | - Flora Y Wong
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC, 3168, Australia
- Monash Newborn, Monash Children's Hospital, Clayton, VIC, 3168, Australia
- Department of Paediatrics, Monash University, Clayton, VIC, 3168, Australia
| | - Calum T Roberts
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC, 3168, Australia
- Monash Newborn, Monash Children's Hospital, Clayton, VIC, 3168, Australia
- Department of Paediatrics, Monash University, Clayton, VIC, 3168, Australia
| | - Stuart B Hooper
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC, 3168, Australia
- Department of Obstetrics and Gynaecology, Monash University, Wellington Rd, Clayton, VIC, 3800, Australia
| | - Graeme R Polglase
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC, 3168, Australia
- Department of Obstetrics and Gynaecology, Monash University, Wellington Rd, Clayton, VIC, 3800, Australia
| | - Peter G Davis
- Department of Obstetrics, Gynaecology, and Newborn Health, The University of Melbourne, Parkville, VIC, 3052, Australia
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, VIC, 3052, Australia
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Ramaswamy VV, Kumar G, Abdul Kareem P, Somasekhara Aradhya A, Suryawanshi P, Sahni M, Khurana S, Sharma D, More K. Comparative efficacy of volume expansion, inotropes and vasopressors in preterm neonates with probable transitional circulatory instability in the first week of life: a systematic review and network meta-analysis. BMJ Paediatr Open 2024; 8:e002500. [PMID: 38769048 PMCID: PMC11110579 DOI: 10.1136/bmjpo-2024-002500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 03/12/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND There exists limited agreement on the recommendations for the treatment of transitional circulatory instability (TCI) in preterm neonates OBJECTIVE: To compare the efficacy of various interventions used to treat TCI METHODS: Medline and Embase were searched from inception to 21st July 2023. Two authors extracted the data independently. A Bayesian random effects network meta-analysis was used. Recommendations were formulated using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework. INTERVENTIONS Dopamine, dobutamine, epinephrine, hydrocortisone, vasopressin, milrinone, volume and placebo. MAIN OUTCOME MEASURES Mortality, major brain injury (MBI) (intraventricular haemorrhage > grade 2 or cystic periventricular leukomalacia), necrotising enterocolitis (NEC) ≥stage 2 and treatment response (as defined by the author). RESULTS 15 Randomized Controlled Trials (RCTs) were included from the 1365 titles and abstracts screened. Clinical benefit or harm could not be ruled out for the critical outcome of mortality. For the outcome of MBI, epinephrine possibly decreased the risk when compared to dobutamine and milrinone (very low certainty). Epinephrine was possibly associated with a lesser risk of NEC when compared with dopamine, dobutamine, hydrocortisone and milrinone (very low certainty). Dopamine was possibly associated with a lesser risk of NEC when compared with dobutamine (very low certainty). Vasopressin possibly decreased the risk of NEC compared with dopamine, dobutamine, hydrocortisone and milrinone (very low certainty). Clinical benefit or harm could not be ruled out for the outcome response to treatment. CONCLUSIONS Epinephrine may be used as the first-line drug in preterm neonates with TCI, the evidence certainty being very low. We suggest future trials evaluating the management of TCI with an emphasis on objective criteria to define it.
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Affiliation(s)
| | - Gunjana Kumar
- Neonatology, National Institute of Medical Sciences and Research, Jaipur, Rajasthan, India
| | | | | | - Pradeep Suryawanshi
- Neonatology, Bharati Vidyapeeth University Medical College & Hospital, Pune, Maharashtra, India
| | - Mohit Sahni
- Neonatology, Surat Kids Hospital, Surat, Gujarat, India
| | | | - Deepak Sharma
- Neonatology, National Institute of Medical Sciences and Research, Jaipur, Rajasthan, India
| | - Kiran More
- Neonatology, MRR Children's Hospital, Thane, Maharashtra, India
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Ali SK, Stanford AH, McNamara PJ, Gupta S. Surfactant and neonatal hemodynamics during the postnatal transition. Semin Fetal Neonatal Med 2023; 28:101498. [PMID: 38040585 DOI: 10.1016/j.siny.2023.101498] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2023]
Abstract
Surfactant replacement therapy (SRT) has revolutionized the management of respiratory distress syndrome (RDS) in premature infants, leading to improved survival rates and decreased morbidity. SRT may, however, be associated with hemodynamic changes, which can have both positive and negative effects on the immature cardiovascular system, during the transitional adaptation from fetal to extrauterine environment. However, there is a relative paucity of evidence in this domain, with most of them derived from small heterogeneous observational studies providing conflicting results. In this review, we will discuss the hemodynamic changes that occur with surfactant administration during this vulnerable period, focusing on available evidence regarding changes in pulmonary and systemic blood flow, cerebral circulation and their clinical implications.
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Affiliation(s)
- Sanoj Km Ali
- Division of Neonatology, Sidra Medicine, Doha, Qatar; University of Tasmania, Australia; Murdoch Children's Research Institute, Melbourne, Australia.
| | - Amy H Stanford
- Pediatrics - Neonatology, Department of Pediatrics, University of Iowa, Iowa City, LW, USA.
| | - Patrick J McNamara
- Division of Neonatology, Department of Pediatrics and Internal Medicine, University of Iowa, Iowa City, LW, USA.
| | - Samir Gupta
- Department of Engineering, Durham University, United Kingdom; Division of Neonatology, Department of Pediatrics, Sidra Medicine, Doha, Qatar.
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Schwaberger B, Pichler G, Baik-Schneditz N, Kurath-Koller S, Sallmon H, Singh Y. Editorial: Cardio-circulatory support of neonatal transition. Front Pediatr 2023; 11:1146395. [PMID: 36861075 PMCID: PMC9969124 DOI: 10.3389/fped.2023.1146395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 01/25/2023] [Indexed: 02/15/2023] Open
Affiliation(s)
- Bernhard Schwaberger
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Gerhard Pichler
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Nariae Baik-Schneditz
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Stefan Kurath-Koller
- Division of Pediatric Cardiology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Hannes Sallmon
- Division of Pediatric Cardiology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.,Department of Pediatric Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Yogen Singh
- Department of Pediatrics - Neonatology and Pediatric Cardiology, Cambridge University Hospitals NHS Foundation Trust and University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom.,Department of Pediatrics - Division of Neonatology, Loma Linda University Children's Hospital and Loma Linda University School of Medicine, Loma Linda, CA, United States
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