Cardiac Output with Delayed Cord Clamping (CO-DCC)
Title: Transitional hemodynamics during delayed cord clamping
Background: The cardiovascular changes and the minimal duration of delayed cord clamping necessary to provide a benefit have never been described in newborns.
Objective: After vaginal delivery term infants were placed on a bed 10-20 cm below the placenta. Transcutaneous sensors were placed on the neck and chest to determine heart rate, stroke volume and cardiac output at each beat using electrical impedance. A baseline for each subject was established by the first 5 data points and the percent change from the baseline was averaged over each minute.
Results: 20 infants were enrolled.
Conclusions: This study provides reference values for changes in cardiac output and stroke volume during delayed cord clamping in well term infants. Although in our study all infants required at least two minutes to reach peak cardiac output, further studies are needed to determine the optimal duration of DCC in preterm infants.
Stroke volume increased from baseline at minutes 3 (11.2%,p=0.005), 4 (16.5%,p=0.0005) and 5 (38.9%,p=0.004) of life. Cardiac output increased from baseline at minutes 2 (9.7%,p=0.0003), 3 (12.6%,p=0.002), 4 (14.5%,p=0.002), and 5 (22.8%,p=0.006). For every minute of life the infant received delay cord clamping (DCC) stroke volume increased 13.1% ± 12.3 (p=0.0001) and cardiac output increased 12.6% ± 6.3 (p=3.9x10-7). While the majority of infants continued to have an increase in cardiac output at 5 minutes of life, 7/20 infants reached their peak cardiac output at 188 ± 41 seconds of life.