| 1. |
- Berg, Johan Henrik Martin, et al.
(författare)
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Effect of Delayed Cord Clamping on Neurodevelopment at 3 Years : A Randomized Controlled Trial
- 2021
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Ingår i: Neonatology. - : S. Karger. - 1661-7800 .- 1661-7819. ; 118:3, s. 282-288
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Iron deficiency (ID) is associated with poor neurodevelopment. We have previously shown that delayed umbilical cord clamping (CC) improves iron stores at 8 months and neurodevelopment at 1 year in term, healthy infants in Nepal.Objective: The aim of this study was to assess the effects of delayed CC (≥180 s) compared to early CC (≤60 s) on neurodevelopment using the Ages and Stages Questionnaire (ASQ) at age 3 years.Methods: In 2014, 540 healthy Nepalese infants born at term were randomized in a 1:1 ratio to delayed or early CC. At 3 years of age, ASQ assessment was performed by phone interviews with parents. A score >1 standard deviation below the mean was defined as "at risk" for developmental impairment.Results: At 3 years of age, 350 children were followed up, 170 (63.0%) in the early CC group and 180 (66.7%) in the delayed CC group. No significant differences in ASQ scores in any domains between groups were found. However, more girls were "at risk" for affected gross motor development in the early CC group: 14 (18.9%) versus 6 (6.3%), p = 0.02.Conclusion: There were no significant differences in ASQ scores in any domains between groups. In the subgroup analysis, fewer girls who underwent delayed CC were "at risk" for delayed gross motor development. Due to the pronounced difference in iron stores at 8 months postpartum in this cohort, follow-up studies at an older age are motivated since neurodevelopmental impairment after early ID may be more detectable with increasing age.
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| 2. |
- Berg, Johan Henrik Martin, et al.
(författare)
-
Effect of Delayed Cord Clamping on Neurodevelopment at 3 Years: A Randomized Controlled Trial.
- 2021
-
Ingår i: Neonatology. - : S. Karger AG. - 1661-7819 .- 1661-7800. ; 118:3, s. 282-288
-
Tidskriftsartikel (refereegranskat)abstract
- Iron deficiency (ID) is associated with poor neurodevelopment. We have previously shown that delayed umbilical cord clamping (CC) improves iron stores at 8 months and neurodevelopment at 1 year in term, healthy infants in Nepal.The aim of this study was to assess the effects of delayed CC (≥180 s) compared to early CC (≤60 s) on neurodevelopment using the Ages and Stages Questionnaire (ASQ) at age 3 years.In 2014, 540 healthy Nepalese infants born at term were randomized in a 1:1 ratio to delayed or early CC. At 3 years of age, ASQ assessment was performed by phone interviews with parents. A score >1 standard deviation below the mean was defined as "at risk" for developmental impairment.At 3 years of age, 350 children were followed up, 170 (63.0%) in the early CC group and 180 (66.7%) in the delayed CC group. No significant differences in ASQ scores in any domains between groups were found. However, more girls were "at risk" for affected gross motor development in the early CC group: 14 (18.9%) versus 6 (6.3%), p = 0.02.There were no significant differences in ASQ scores in any domains between groups. In the subgroup analysis, fewer girls who underwent delayed CC were "at risk" for delayed gross motor development. Due to the pronounced difference in iron stores at 8 months postpartum in this cohort, follow-up studies at an older age are motivated since neurodevelopmental impairment after early ID may be more detectable with increasing age.
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| 3. |
- Isacson, Manuela, et al.
(författare)
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Midwives’ decision-making process when a non-vigorous neonate is born – a Swedish qualitative interview study
- 2022
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Ingår i: Midwifery. - : Elsevier BV. - 0266-6138. ; 114
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Midwives are often the first ones to make decisions when a neonate is unexpectedly born non-vigorous. This study aimed to understand how midwives reason and what they experience when deciding what to do when a non-vigorous neonate is born. In present practice, the decision to cut the umbilical cord early is strongly affected bythe decision that the neonate needs resuscitation. To better understand the decisions taken during the first minutes of the non-vigorous neonate's life, this study focused on the midwives' decision to cut the umbilical cord. Design:: A qualitative study with an inductive and descriptive design using the Critical Incident Technique was chosen to gain a more in-depth understanding of the factors influencing the midwife's decision-making process concerning cutting the umbilical cord in a critical situation. Semi-structured interviews were conducted, and thematic analysis, as described by Braun and Clarke, was performed. Setting and participants:: Eligible study participants were midwives currently working in labour wards in Sweden. Findings: In total, 14 midwives were interviewed between November 2019 and March 2020. The interviews rendered an understanding about midwives' decision-making on the timing of cord clamping in the non-vigorous neonates. An overarching theme was generated: "The balancing act of clamping the umbilical cord" which consisted of three themes, "Assessing the neonate in need of resuscitation", "Valuing own knowledge and experience" and "Influencing decision-making", and seven sub-themes. Many factors in addition to clinical reasoning influenced the midwives' decision-making processes. Feelings, intuition, and experience also had an effect to varying degrees.
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| 4. |
- Isacson, Manuela, et al.
(författare)
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Neurodevelopmental outcomes of a randomised trial of intact cord resuscitation.
- 2021
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Ingår i: Acta paediatrica (Oslo, Norway : 1992). - : Wiley. - 1651-2227 .- 0803-5253. ; 110:2, s. 465-472
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Tidskriftsartikel (refereegranskat)abstract
- It has been suggested that intact cord resuscitation can reduce the risk of brain damage. We investigated the effects on neurodevelopment at two years of age.This study was performed in Kathmandu, Nepal. In 2016, 231 late preterm and term infants born vaginally and not breathing were randomised to resuscitation with an intact cord or the standard practice of early cord clamping (CC). At two years of age, the World Health Organization's Infant and Young Child Development tool was used to assess the child's neurodevelopment, during telephone interviews with caregivers.We followed up 138 infants (59.7%) at a mean age of 24.8 ± 0.8 months. A significant difference was seen in the development for age Z-score, between the group resuscitated with an intact umbilical cord and the group resuscitated with early CC. The median (range) scores were 1.0 (0.1-2.1) vs 0.9 (-2.0 to 1.8), respectively (P = .04). There was no difference in the motor, language-cognitive and socio-emotional domains.Neurodevelopment improvements were observed at two years of age in infants resuscitated with an intact rather than early clamped umbilical cord. No definitive conclusions could be drawn due to protocol violations and a low follow-up rate. More research is needed.
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| 5. |
- Isacson, Manuela, et al.
(författare)
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Umbilical cord clamping and management of the third stage of labor : A telephone-survey describing Swedish midwives’ clinical practice
- 2022
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Ingår i: European Journal of Midwifery. - : European Publishing. - 2585-2906. ; 6, s. 1-7
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Tidskriftsartikel (refereegranskat)abstract
- Introduction:The timing of cord clamping impacts children’s short- and longterm well-being. When making clinical decisions, midwives incorporate their tacit and professional knowledge, experience and current evidence. There appears to be a lack of knowledge regarding Swedish midwives’ management of the third stage of labor and cord clamping practice. The aim of this study was to explore Swedish midwives’ clinical practice concerning umbilical cord clamping and the third stage of labor in spontaneous vaginal births.Methods:The study was designed as a cross-sectional telephone survey including 13 questions. Midwives were randomly selected from 48 births units in Sweden. Two midwives from each unit were interviewed. The primary outcome was timing of umbilical cord clamping practice in full-term infants. Secondary outcomes were the management of the third stage of labor including prophylactic use of synthetic oxytocin, the timing of cord clamping in preterm infants, controlled cord traction, uterine massage, and cord milking.Results:Altogether, 95 midwives were interviewed. In full-term infants, all midwives preferred late cord clamping. Considerable heterogeneity was seen regarding the practices of synthetic oxytocin administration postpartum, controlled cord traction, uterine massage or cord milking, and cord clamping in preterm infants.Conclusions:Midwives in Sweden modify recommendations regarding delayed cord clamping in a way they might perceive as more natural and practical in their daily, clinical work. The study revealed a reluctance toward the administration of prophylactic oxytocin due to fear that the drug could pass to the infant. An overall large variation of the management of the third stage of labor was seen.
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| 6. |
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| 7. |
- Moberg, Christina, et al.
(författare)
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De unga gör helt rätt när de stämmer staten
- 2022
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Ingår i: Aftonbladet. - 1103-9000.
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Tidskriftsartikel (populärvet., debatt m.m.)abstract
- 1 620 forskare och lärare i forskarvärlden: Vi ställer oss bakom Auroras klimatkrav
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| 8. |
- Winkler, Andreas, et al.
(författare)
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Cord clamping beyond 3 minutes : Neonatal short-term outcomes and maternal postpartum hemorrhage
- 2022
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Ingår i: Birth. - : Wiley. - 0730-7659 .- 1523-536X. ; 49:4, s. 783-791
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Delaying cord clamping (CC) for 3-5 minutes reduces iron deficiency and improves neurodevelopment. Data on the effects of CC beyond 3 minutes in relation to short-term neonatal outcomes and maternal risk of postpartum hemorrhage are scarce.METHODS: This was a prospective observational study performed in two delivery departments. Pregnant women with vaginal deliveries were included. Time to CC, estimated postpartum blood loss, and perinatal data were recorded. Spearman's correlation analysis and comparisons between newborns clamped before and after 3 minutes were performed.RESULTS: In total, 904 dyads were included. The mean gestational age ± standard deviation was 40.1 ± 1.2 weeks. CC was performed at a median time of 6 minutes (range 0-23.5). Apgar scores at 5 and 10 minutes were positively correlated with time to CC (correlation coefficient .140, P < .001 and .161, < .001). There was no correlation between CC time and bilirubin level (correlation coefficient .021, P = .54). The median postpartum blood loss was 300 mL (70-2550 mL), with a negative correlation between CC time and postpartum blood loss (-0.115, P = .001). The postpartum blood loss was larger in the group clamped at ≤3 minutes (median [interquartile range] 400 mL [300-600] vs 300 mL [250-450], [P = .003]].CONCLUSIONS: Umbilical CC times beyond 3 minutes in vaginal deliveries were not associated with negative short-term outcomes in newborns and were associated with a smaller maternal postpartum blood loss. Although CC time as long as 6 minutes could be considered as safe, further research is needed to decide the optimal timing.
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