195 - Hemodynamic changes with umbilical cord milking in non-vigorous infants

Poster Number: 195
Publication Number: 195.219

Anup Katheria, Sharp Mary Birch Hospital for Women & Newborns, SAN DIEGO, CA, United States; Yogen Singh, Loma Linda University School of Medicine, Loma Linda, CA, United States; Debra M. Poeltler, Sharp HealthCare, San Diego, CA, United States; Wade D. Rich, Sharp Mary Birch Hospital for Women and Newborns, San Diego, CA, United States; Ana L. Morales, Sharp Healthcare Neonatal Research Institute, San Diego, CA, United States; paul R. wozniak, Sharp Mary Birch Hospital, san diego, CA, United States; Neil N. Finer, University of California, San Diego School of Medicine, La Jolla, CA, United States

Background: UCM has demonstrated improved blood pressure and increased systemic blood flow in preterm infants. However it is unclear whether there are hemodynamic differences in non-vigorous infants who may potentially have hypovolemia at birth.

Objective: To establish the hemodynamic safety and efficacy of UCM compared with early cord clamping in non-vigorous newborns enrolled in a large multicenter cluster crossover trial (MINVI trial).

Design/Methods: Non-vigorous infants enrolled in the parent MINVI trial at 2 of 10 MINVI centers were eligible for an optional ancillary echocardiogram study. If the parent consented, echocardiographic measurements were performed at 12 hours +/-6 hours of age by research sonographers blinded to infant randomization group. The primary outcome was cardiac output as measured by left ventricular output (LVO, ml/kg/min). Additional measurements were taken according to a standard operating procedure to assess systemic blood flow, by superior vena cava (SVC) flow (ml/kg/min), right ventricular output (ml/kg/min), left ventricular output (LVO) (ml/kg/min), measures of systolic strain, diastolic velocity, isovolemic contraction, TAPSE, and ductal shunt when present were measured and compared between groups as per intention to treat analysis.

Results: Out of 448 eligible infants enrolled at two participating centers, 226 had an echocardiogram performed. Demographics are shown in table 1. Non-vigorous infants receiving UCM had better hemodynamics as measured by higher left and right ventricular output, and svc flow, and less strain as measured by peak longitudinal and circumferential strain (see table 2). However, infants receiving UCM had a lower TAPSE.Conclusion(s): Intact cord milking improved left and right ventricular outputs and reduced measures of strain compared with early cord clamping in non-vigorous newborns. Decreased TAPSE may reflect increased right ventricular overload. Overall improvements in cardiac function with umbilical cord milking need to be correlated with clinical outcomes before it can be recommended for non-vigorous newborns.
Table 1 Demographics
Table 2 Echocardiographic Parameters by group.