P0732 - Effects of Placental Transfusion on Late Preterm Infants Admitted to a Mother-Baby Unit

Background: Delayed cord clamping (DCC) and umbilical cord milking (UCM), the methods used to increase placental blood transfusion to the newborn are associated with increased hemoglobin levels after birth, improved iron stores after several months of life, and greater myelination in early developing brain. Evidence suggests that clamping the umbilical cord in all births should be delayed for at least one minute. UCM also appears to be safe especially in a cesarean section scenario, where waiting too long to delay the cord clamping may not be feasible. Well-appearing late preterm infants admitted to a mother-baby unit may benefit from placental transfusion, but there are concerns of short-term adverse effects of increased blood volume. A placental transfusion guideline was drafted and implemented at our community hospital beginning August 1st 2017 for late preterm infants born 35 0/7 to 36 6/7 weeks’ gestation. The infants born via vaginal delivery would have DCC performed for at least for three minutes if placed skin to skin with the mother or at least one minute if held at or below the level of placenta. The infants born via cesarean section would get UCM performed 5 times. Obstetric and newborn providers were educated about this guideline prior to August.

Objective: The purpose of the study is to examine the short-term effects of placental transfusion on infants born 35 0/7 to 36 6/7 weeks gestation and admitted to a mother-baby unit. We hypothesized that placental transfusion (DCC or UCM) is safe and not associated with increased incidence of hyperbilirubinemia needing phototherapy, symptomatic polycythemia, neonatal intensive care unit (NICU) admission, or readmission for phototherapy compared to a historic cohort of immediate cord clamping (ICC).
Methods/Design: In this pre and post intervention retrospective cohort study we compared 161 infants born 35 0/7 to 36 6/7 weeks gestation who had placental transfusion (DCC or UCM) born during a two-year period after guideline implementation (post-intervention period; 8/1/2017 to 7/31/2019) to 118 infants who had ICC born during a two-year period before implementation (pre-intervention period; 8/1/2015 to 7/31/2017).

Results: There were no significant differences in maternal and infant characteristics between both placental transfusion and ICC groups (Tables 1&2). The mean hematocrit after birth was significantly higher in the placental transfusion group. The proportion of infants born with a hematocrit less than 40 were significantly lower in the placental transfusion group. No differences were found in the occurrence of hyperbilirubinemia needing phototherapy, symptomatic polycythemia, NICU admission, or readmission for phototherapy between groups (Table 2).

Conclusion: Placental transfusion (DCC or UCM) as performed in our hospital was safe and effective. It was not associated with increased incidence of hyperbilirubinemia needing phototherapy, symptomatic polycythemia, NICU admission, or readmission to the hospital for phototherapy.