Estudio aleatorizado de ligadura tardía versus ligadura precoz del cordón umbilical en recién nacidos entre las semanas 24 y 34 de gestación

Abstract

OBJECTIVES OF THE STUDY: • Assess the influence of early and late clamp on clinical, hematological and biochemical parameters in preterm newborns, by vaginal delivery and/or cesarean section during their hospital stay • Hematological status at 7 days of life • Evaluation of echocardiographic results during the first week of life by the Pediatric Cardiology Unit. • Hematological status by performing a control blood count 48 hours postpartum. During the years 2010-2014, 98 pregnancies were selected that ended between 24+0-34+0 weeks of gestation in the Gynecology and Obstetrics service of the Virgen de la Arrixaca University Hospital that met the following inclusion criteria: • Single pregnancies ending between 24+0 and 34+0 weeks of gestation • Bichorial-Diamniotic twin pregnancies that ended between 24+0 and 34+0 weeks of gestation Results In our study we were able to demonstrate that the implementation of late cord clamp can be carried out in a systematic, protocolized and safe manner without interfering with the neonatal care of the preterm newborn, and that it can even improve it since the newborns who underwent late ligation presented higher values in the Apgar Test at one minute and at five minutes of life One of the most relevant results of our study and that highlights the benefits and safety of performing late clamp is the improvement in hematological parameters, both hemoglobin and hematocrit, presented by newborns belonging to this group, with the consequent lower need for transfusion of blood products, a fact that becomes even more relevant in third world countries where iron deficiency and other causes of anemia in newborns are even more prevalent. Another finding of great interest was the verification that there are no significant differences when analyzing the decrease in maternal hemoglobin and hematocrit after the implementation of late clamping. With regard to the data obtained with neonatal echocardiography, we wanted to study whether performing late clamp in the premature newborn would imply a greater blood supply to the newborn and, therefore, an increase in blood volume, and if this, it could be reflected in echocardiographic parameters early. In our study, comparing the data obtained in echocardiography by measuring the diastolic volume of the left ventricle, as well as the ejection fraction, we did not find significant differences that could make us think that late clamp of the umbilical cord could have an impact on the hemodynamic changes in the preterm newborn. Similarly, there were no statistically significant differences in the patent ductus arteriosus.