477 - Physiologically Based Cord Clamping in Infants with Congenital Diaphragmatic Hernia (CDH): A Single Center’s Experience

Poster Number: 477
Publication Number: 477.230

Jiyoon Jeong, Asan Medical Center Children's Hospital, Seoul, Seoul-t'ukpyolsi, Republic of Korea; Teahyen Cha, Asan medical center childrens hospital, Seoul, Seoul-t'ukpyolsi, Republic of Korea; Byong Sop Lee, University of Ulsan College of Medicine, Seoul, Seoul-t'ukpyolsi, Republic of Korea; Ki-soo Kim, Asan Medical Center, children's hospital, Seoul, Seoul-t'ukpyolsi, Republic of Korea; Euiseok Jung, Asan Medical Center, Seoul, Seoul-t'ukpyolsi, Republic of Korea; Ellen Ai-Rhan Kim, Asan Medical Center, Seoul, Seoul-t'ukpyolsi, Republic of Korea

Background:  Infants with congenital diaphragmatic hernia (CDH) often experience hypoxemia with acidosis immediately after birth. The traditional approach in the delivery room is immediate cord clamping (ICC) followed by intubation. Starting resuscitation before umbilical cord clamping at birth may gradually increase pulmonary blood flow while umbilical venous blood flow is still contributing to oxygenation and maintenance of left ventricular preload. 

Objective: The aim of study is to evaluate the feasibility and effects of physiologically based cord clamping (PBCC) on cardiopulmonary adaptation at birth in newborn infants with CDH.

Design/Methods: This was observational pilot study in neonatal intensive care unit of Asan Medical Center Children’s Hospital from December 2020 to November 2021. Infants with isolated CDH and gestational age ≥ 36 weeks were included. Infants was placed on a trolley immediately after birth with an intact umbilical cord, intubated and ventilated. PBCC group was compared with matched historical controls, identified from an ongoing Asan CDH registry from 2008 to 2019. The PBCC group (n=9) was 1:4 matched with the historical controls (n=36) for gestational age (± 1 week), birth weight (± 500 g), laterality, and observed to expected lung to head ratio (O/E LHR). Maternal outcomes and neonatal prognostic variables were compared between two groups.

Results: Antenatal and postnatal markers of CDH severity were similar between two groups. No increase in maternal or neonatal adverse events were observed in PBCC group. Initial hemoglobin level was higher in PBCC group than ICC group (17.0 ± 1.6 vs. 18.4 ± 1.0;P=0.013). Mean blood pressure was significantly higher in the PBCC than in the ICC group (P=0.044). Use of vasopressor within 48 hours (81% vs. 44%;P=0.043), and inhaled nitric oxide (53% vs. 11%;P=0.030) were more frequent in the ICC than in the PBCC group. Extracorporeal membrane oxygenation (33% vs. 22%;P=0.698) and mortality (36% vs. 22%;P=0.695) were not significantly different between two groups. Blood gas and mechanical ventilator parameters did not significantly differ between two groups.Conclusion(s): Initiation of ventilation before cord clamping is feasible in infants with CDH. Better results for initial hemoglobin, mean blood pressure and use of vasopressors within 48 hours indicate that PBCC may support the cardiopulmonary transition at birth in infants with CDH. A prospective, randomized control trial is currently in progress at our hospital.