PubMed · 2129333
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K H Nicolaides. 1990. Fetal therapy.. https://pubmed.ncbi.nlm.nih.gov/2129333/
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Due to the bowel's poor tolerance of hypoxia, intestinal malperfusion presents as a grave disease with high mortality. The intensivist is confronted with this condition in association with other underlying diseases, in the course of surgery, during application of medication or associated with invasive therapy. In a critical care setting, the non-occlusive mesenteric ischemia (NOMI) is of increasing importance. Since critical care patients often lack clinical symptoms, special attention is required and one main factor of the patient's prognosis is early diagnosis. This review summarizes pathophysiology and diagnostic aspects and the range of therapeutic and preventive measures.
BACKGROUND: Optimal timing for clamping of the umbilical cord at birth is unclear. Early clamping allows for immediate resuscitation of the newborn. Delaying clamping may facilitate transfusion of blood between the placenta and the baby. OBJECTIVES: To delineate the short- and long-term effects for infants born at less than 37 completed weeks' gestation, and their mothers, of early compared to delayed clamping of the umbilical cord at birth. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register (2 February 2004), the Cochrane Neonatal Group trials register (2 February 2004), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 1, 2004), PubMed (1966 to 2 February 2004) and EMBASE (1974 to 2 February 2004). SELECTION CRITERIA: Randomized controlled trials comparing early with delayed (30 seconds or more) clamping of the umbilical cord for infants born before 37 completed weeks' gestation. DATA COLLECTION AND ANALYSIS: Three reviewers assessed eligibility and trial quality. MAIN RESULTS: Seven studies (297 infants) were eligible for inclusion. The maximum delay in cord clamping was 120 seconds. Delayed cord clamping was associated with a higher hematocrit four hours after birth (four trials, 134 infants; weighted mean difference 5.31, 95% confidence interval (CI) 3.42 to 7.19), fewer transfusions for anaemia (three trials, 111 infants; relative risk (RR) 2.01, 95% CI 1.24 to 3.27) or low blood pressure (two trials, 58 infants; RR 2.58, 95% CI 1.17 to 5.67) and less intraventricular haemorrhage (five trials, 225 infants; RR 1.74, 95% CI 1.08 to 2.81) than early clamping. REVIEWERS' CONCLUSIONS: Delaying cord clamping by 30 to 120 seconds, rather than early clamping, seems to be associated with less need for transfusion and less intraventricular haemorrhage. There are no clear differences in other outcomes.
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