734 - Lung recruitment with CPAP at birth with an intact cord versus lung recruitment with CPAP after cord clamping in preterm infants

Publication Number: 1711.734

Giuseppe De Bernardo, Ospedale Buon Consiglio Fatebenefratelli, Napoli, Campania, Italy; Maurizio Giordano, Federico II University, Naples, Campania, Italy; Salvatore Spalice, NA, Napoli, Campania, Italy; Valentina Fattorusso, Ospedale Madonna del Buon Consiglio, Fatebenefratelli Napoli, Naples, Campania, Italy; Violante Fonterico, Ospedale Fatebenefratelli Napoli, Napoli, Campania, Italy; Desiree Sordino, Department of Woman and Child, Buon Consiglio Fatebenefratelli Hospital, Naples, Italy., Napoli, Campania, Italy

Background: During the fetal period, pulmonary blood flow is minimal due to high pulmonary vascular resistance, and systemic circulation is primarily supported through the ductus arteriosus and umbilical-placental circulation. Delayed cord clamping (DCC) has been shown to promote a more physiological transition to extrauterine life, improving hematologic and cardiovascular stability in both term and preterm infants. Recent evidence suggests that initiating lung aeration before cord clamping may further optimize hemodynamic stability by maintaining left ventricular preload and reducing postnatal circulatory stress.

Objective: Primary outcomes were to evaluate hematocrit and hemoglobin at 12 and 48 hours while secondary outcomes included the incidence and severity of IVH, NEC, and ROP.

Design/Methods: A prospective observational cohort study was conducted at Buon Consiglio Fatebenefratelli Hospital. Inborn preterm infants ( < 32 weeks' gestation and/or birth weight < 1500 g) were observed according to the clinical management received at birth: the case group received early CPAP during the transitional period before cord clamping, while the control group underwent delayed cord clamping (30 s) followed by CPAP. Infants with severe fetal conditions, suspected anemia, multiple gestations (>2 fetuses), emergency cesarean sections, or conditions deemed unsuitable by clinicians were excluded.

Results: A total of 14 and 9 preterm newborns were enrolled in the control and case groups, respectively. No statistically significant differences were observed between the case and control groups for any of the analyzed parameters. Median gestational age and birth weight were comparable between groups. Hematocrit and hemoglobin levels at birth and at 48 hours showed a trend toward higher values in the case group. Furthermore, pH and glycemia values at birth and 48 hours were similar across groups. The incidence of intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP) and the need for intubation were lower in the case group but they did not differ significantly (Table 1).

Conclusion(s): In this study no significant differences were observed between groups. However, infants ventilated with CPAP before cord clamping showed higher hematocrit and hemoglobin values and lower rates of complications. These findings suggest that maintaining an intact cord during early respiratory support may promote a smoother cardio-respiratory transition at birth.

Table 1: Comparison of demographic, hematologic, metabolic, and clinical outcomes between control and case groups of preterm infants.