Publication: Umbilikal kord sağma tekniğinin ve klempleme zamanının yenidoğan bebeklerdeki erken postnatal oksijenasyon ve klinik parametrelere etkisi
Abstract
Amaç: Çalışmamızın amacı, umbilikal kord sağma, erken ve geç umbilikal kord klempleme tekniklerinin postnatal ilk dakikalardaki oksijen saturasyonları ve üçüncü aydaki hemoglobin ve ferritin düzeylerine etkisinin ortaya konmasıdır. Gereç ve Yöntem: Bu randomize prospektif çalıĢmada Marmara Üniversitesi Pendik Eğitim ve AraĢtırma Hastanesi' nde Ocak 2014-Nisan 2015 tarihleri arasında 35-42 gebelik haftası (GH) arasında doğan 240 bebek, erken kord klempleme, geç kord klempleme ve umbilikal kord sağma gruplarına randomize Ģekilde dahil edildi. Bebeklerin 1., 5. ve 10. dakika (dk) Apgar skorları, postnatal 4. ve 24. saatte hematokrit (Hct), hemoglobin (Hb), bilirubin değerleri, postnatal 3. aydaki Hct, Hb ve ferritin düzeyleri kaydedildi. Gebelik haftaları 37-42 hafta olan bebeklerden ise 1., 3., 5. ve 10. dk oksijen saturasyonu (SpO2), kalp hızı ile perfüzyon indeksi (PĠ) değerleri, umbilikal kord pH, HCO3, laktat değerleri kaydedildi. Bulgular: Erken kord klempleme, geç kord klempleme ve umbilikal kord sağma (milking) grupları arasında cinsiyet, doğum Ģekli, doğum ağırlığı, GH, Apgar 1., 5., 10. dk skorları, 4. saat ve 24. saat bilirubin değerleri açısından fark bulunmadı. Gebelik haftaları 37-42 hafta olan bebeklerde, 3 grup arasında nabız oksimetresi postnatal okuma zamanı, 1., 3., 5. ve 10. dk SpO2, kalp hızı ile perfüzyon indeksi (PĠ) değerleri açısından fark saptanmadı. Gruplar arasında 3. ay ferritin, Hb ve Hct değerleri bakımından istatistiksel olarak anlamlı farklılık saptanmadı (p˃0.05). Erken kord klempleme grubunda, geç kord klempleme ve umbilikal kord sağma gruplarına göre 4. saat ve 24. saat Hct istatistiksel olarak anlamlı derecede daha düĢük saptandı (p˂0.001). Erken kord klempleme grubunda umbilikal kord sağma grubuna göre 24. saat Hb istatistiksel olarak anlamlı derecede daha düĢük bulundu (p˂0.01). Sonuç: ÇalıĢmamızda erken kord klemplemeye göre, umbilikal kord sağmanın daha yüksek 4. saat Hb ile 4. ve 24. saat Hct değerlerine yol açtığı gösterilmiĢtir. Farklı kord klempleme uygulamalarının yapılması, bebeklerin postnatal ilk 10 dakikadaki SpO2 ve kalp hızını etkilememiĢtir. Daha geç dönemdeki Hb, Hct ve ferritin değerleri üzerine etkilerinin değerlendirilebilmesi için daha uzun takip süreli daha fazla çalıĢma yapılması gerekmektedir. Ferritin, kord klempleme, kord sağma, oksijen saturasyonu, yenidoğan.
Aim: The objective of this study was to investigate the effect of umbilical cord milking, early or delayed umbilical cord clamping on oxygen saturation in the first minutes of life and hemogram and ferritin values at three months of age. Material and Methods: In this randomised prospective trial, a total number of 240 infants who were born at Marmara University Pendik Education and Training Hospital between January 2014-April 2015 with a gestational age (GA) of 35-42 weeks were randomly assigned to early cord clamping (ECC), delayed cord clamping (DCC)and umbilicak cord milking (UCM) groups. Apgar scores at 1st, 5th, 10th minutes, hematocrit (Hct), hemoglobin (Hb), bilirubin values at 4 and 24 hours of age, Hct, Hb, and ferritin values at 3 month of age were recorded. Postnatal oxygen saturation (SpO2), heart rate and perfusion index at 1st, 3th, 5th and 10th minutes, umbilical cord blood pH, HCO3, lactat values in the neonates who are 37-42 weeks. Results: Gender, delivery type, birth weight, GA, Apgar scores at 1st, 3th, 5th and 10th minutes, bilirubin at 4 and 24 hours of age, were not statistically different between ECC, DCC and UCM groups (p˃0.05). SpO2 , heart rate and perfusion index (PI) values at 1st, 3th, 5th and 10th minutes of age, postnatal reading time on pulseoximeter, were not statistically different between ECC, DCC and UCM groups (p˃0.05). Ferritin, Hb, and Hct values were not statistically different between ECC, DCC and UCM groups at 3 month of age (p˃0.05). Hct at 4 and 24 hours of age were statistically lower in ECC than DCC and UCM groups (p˂0.001) and Hb at 24 hours of age was lower in ECC than UMC group (p˂0.01). Conclusion: Our study demonstrated that umbilical cord milking leads to higher Hb at 4th hours of age and Hct at 4th and 24th hours of age than early cord clamping. Different cord clamping practices did not affect the SpO2, heart rate and PI values of neonates in the first 10 minutes. Further studies with longer follow-ups are needed to establish the effects on Hb, Hct and ferritin values later in infancy. Cord clamping, cord milking, ferritin, neonate, oxygen saturation
Aim: The objective of this study was to investigate the effect of umbilical cord milking, early or delayed umbilical cord clamping on oxygen saturation in the first minutes of life and hemogram and ferritin values at three months of age. Material and Methods: In this randomised prospective trial, a total number of 240 infants who were born at Marmara University Pendik Education and Training Hospital between January 2014-April 2015 with a gestational age (GA) of 35-42 weeks were randomly assigned to early cord clamping (ECC), delayed cord clamping (DCC)and umbilicak cord milking (UCM) groups. Apgar scores at 1st, 5th, 10th minutes, hematocrit (Hct), hemoglobin (Hb), bilirubin values at 4 and 24 hours of age, Hct, Hb, and ferritin values at 3 month of age were recorded. Postnatal oxygen saturation (SpO2), heart rate and perfusion index at 1st, 3th, 5th and 10th minutes, umbilical cord blood pH, HCO3, lactat values in the neonates who are 37-42 weeks. Results: Gender, delivery type, birth weight, GA, Apgar scores at 1st, 3th, 5th and 10th minutes, bilirubin at 4 and 24 hours of age, were not statistically different between ECC, DCC and UCM groups (p˃0.05). SpO2 , heart rate and perfusion index (PI) values at 1st, 3th, 5th and 10th minutes of age, postnatal reading time on pulseoximeter, were not statistically different between ECC, DCC and UCM groups (p˃0.05). Ferritin, Hb, and Hct values were not statistically different between ECC, DCC and UCM groups at 3 month of age (p˃0.05). Hct at 4 and 24 hours of age were statistically lower in ECC than DCC and UCM groups (p˂0.001) and Hb at 24 hours of age was lower in ECC than UMC group (p˂0.01). Conclusion: Our study demonstrated that umbilical cord milking leads to higher Hb at 4th hours of age and Hct at 4th and 24th hours of age than early cord clamping. Different cord clamping practices did not affect the SpO2, heart rate and PI values of neonates in the first 10 minutes. Further studies with longer follow-ups are needed to establish the effects on Hb, Hct and ferritin values later in infancy. Cord clamping, cord milking, ferritin, neonate, oxygen saturation