الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Neonatal resuscitation is the most frequently practiced form of resuscitation in medical care. During the birth of every newborn, the potential need for resuscitation must be anticipated. Thus, at least one clinician who is skilled in basic neonatal resuscitation should be present at every delivery, and this person must be available exclusively to assess the infant and provide intervention. Risk factors that increase the likelihood for the need for resuscitation should be ascertained before delivery, if possible, and provision of additional personnel trained in advanced resuscitation should be arranged.
The physiological transition from the placental life support system to all the independent corresponding organ systems of the newborn involves much more than ventilation of the lungs. Placental transfusion has only recently been recognized as an important factor in this fetal/neonatal transition. Support of the placental function by placental transfusion is thus rational priorities in the revival of a depressed neonate.
Delayed cord clamping (DCC) should be the standard of care for all vigorous term and preterm newborn. Umbilical cord milking is an alternative to DCC that could facilitate placental transfusion and thus better hemodynamic transition in depressed neonates.
The aim of this work was to study the feasibility of doing intact umbilical cord milking as a method of placental transfusion in term neonates who were born depressed and needed resuscitation and to study its hemodynamic effects using echocardiography.
We conducted a randomized, non-blinded, controlled clinical trial during the period from 1/3/2018 to 31/8/2018 on all neonates admitted to NICU at AMUCH.
The study included 66 neonates. They were randomized according to their month of delivery. Those who were delivered in the first 3 months of the study received I-UCM (30 neonates) and those delivered in the next 3 months received ICC (36 neonates). Echocardiography was done for all neonates at 6-12 hours and at 24-36 hours of life.
Differences among the 2 studied groups in terms of demographic characteristics, maternal obstetric history, maternal antenatal medical problems, delivery data, perinatal risk factors, resuscitation data, different laboratory parameters, need for mechanical ventilation, its duration, need for inotropic support and/or vasopressors, echocardiographic data and duration of hospital stay were all evaluated.
In the current study, it was found that time taken to clamp the cord among milking group was statistically longer but was less than 20 seconds and the time to take the first breath among I-UCM group members were statistically lower than the control group. Furthermore, the heart rate and Apgar scores were statistically higher in the milking group.
Hemoglobin and hematocrit levels at 12 hours of life were statistically higher among milking group with the resultant non-need for packed red blood cell transfusion during NICU stay in comparison to the control group without increasing the risk of need for phototherapy.
Umbilical cord milking neither increased the resuscitation requirements nor resulted in a higher number of HIE cases. On the contrary, it facilitated the transition, resulted in better hemodynamics as evidenced by higher mean arterial pressure, better cardiac parameters including TAPSE and EF%.
Also, a lower incidence of pulmonary arterial hypertension was encountered among the milking group.
No statistically significant difference was encountered between the 2 studied groups regarding the superior vena cava flow.
Finally, there wasn’t a statistically significant difference regarding the mortality among the 2 groups, but the hospital stay was statistically shorter among the milking group.