Extrauterine placental perfusion and oxygenation in infants with very low birth weight

1. This randomized clinical trial showed that  very low birth weight (VLBW) infants who received extrauterine placental perfusion (EPP) had similar postnatal hematocrit levels compared to those who received delayed cord clamping (DCC)

2. The EPP group demonstrated significantly higher postnatal peripheral and cerebral oxygenation. 

Evidence Rating Level: 1 (Excellent)

DCC for at least 30 seconds in preterm infants improves survival and reduces complications. These benefits may be attributed to adequate lung aeration before cord clamping, also known as physiological-based cord clamping. Current recommendations do not consider VLBW infants who might lack sufficient lung aeration prior to clamping. An alternative approach involves cesarean-born infants with the placenta still attached and subsequent respiratory support, termed EPP. The EXPLAIN trial aims to evaluate the efficacy of EPP compared with DCC. The trial enrolled and randomized 60 infants with a gestational age greater than 23 weeks and birth weight less than 1500g born by cesarean delivery in a 1:1 ratio to receive EPP (intervention) and DCC (control). The primary outcome—mean (SD) hematocrit levels 24 hours after birth—was comparable between the EPP and DCC groups, with 56.0% (1.8%) and 53.9% (1.8%), respectively. Compared to infants in the control group, those in the EPP group exhibited significantly higher peripheral oxygen saturation (adjusted mean difference at 5 minutes, 15.3% [95% CI, 2.0% to 28.6%]; P=0.04) and regional cerebral oxygen saturation (adjusted MD at 5 minutes, 11.3% [95% CI, 2.0% to 20.6%]; P=0.01). There were no significant differences in other predefined neonatal outcome parameters, but there was a significantly higher mean maternal blood loss during cesarean delivery in the intervention group (P=0.05). This increase is not considered clinically significant by obstetricians. Overall, the findings of the first trial of EPP suggest that while EPP showed comparable postnatal hematocrit levels to DCC, peripheral and cerebral oxygenation during the transition period were significantly higher. Larger trials are required to fully assess EPP’s impact on neonatal outcomes.

Click to read the study in JAMA Network Open

Image: PD

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