Effect of placental transfusion on neonatal resuscitation attempts
Abstract
Objective:
Overall, neonatal mortality has been shown to be reduced by: placental transfusion (the transfer of blood from the placenta to the neonatal circulation after birth); delayed cord clamping (DCM) (waiting for the umbilical cord to stop pulsating before clamping and cutting the cord); and umbilical cord milking (UCM) (clamping and cutting the cord immediately before milking the cord towards the neonate to expel remaining volume). This systematic review aimed to determine whether placental transfusion negatively impacts resuscitation by delaying it or has any effect on infant mortality, and to identify any barriers to performing it.
Methods:
CINAHL, MEDLINE, AMED and the British Nursing Index were searched using key terms to identify relevant English language publications between 2017 and 2019.
Results:
Five papers were selected for critical analysis—three randomised control trials and two cohort studies.
Conclusion:
Placental transfusion was not found to have a negative impact on neonatal resuscitation but, equally, had no significant effect on Apgar at 5 minutes; however, Apgar is a crude measure of infant mortality. The question remains around the proven multifaceted benefit of placental transfusion in the prehospital environment, which requires further research. There is evidence to suggest prehospital clinicians should be looking to change practice. Further research, considerations and consultations are required to ascertain the best way to implement the procedure with a balanced and proportionate approach considering neonatal thermoregulation and maternal management. The main reported barrier to placental transfusion was a lack of appropriate equipment.
Placental transfusion (the transfer of blood from the placenta to the neonatal circulation after birth) can improve blood volume by up to 30% and decrease overall neonatal mortality (Backes et al, 2014). Currently, only vigorous (healthy) babies are treated via this strategy (Mercer Erickson-Owens, 2014; Song et al, 2017). Worldwide, 5% of babies born will require some form of resuscitation to promote adequate ventilation (Blank et al, 2018). Despite the potential benefit that placental transfusion can bring, a need to resuscitate can often interfere with the prehospital clinician's ability to perform transfusion.
When a newborn is delivered in a compromised state, the current prehospital guidelines from the Resuscitation Council UK (2015) and the Joint Royal Colleges Ambulance Liaison Committee (JRCALC) (2019) advocate cutting the umbilical cord immediately so the newborn can be moved to an appropriate setting to initiate resuscitation. The resuscitation algorithm accepted internationally for newborns is quite different from that for adult or child life support. The focus is on optimising airway management and inflating the lungs as, for most babies, this will be all that is needed (Resuscitation Council UK, 2015). It is widely accepted that placental transfusion by delayed cord clamping (DCC) or umbilical cord milking (UCM) should be undertaken for all vigorous newborns and this is reflected in current guidelines.
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