Effect Of Delayed Cord Clamping Vs Umbilical Cord Milking On Cerebral Blood Flow In Preterm Infants

Objective: To explore the effects of delayed cord clamping and umbilical cord milking on Cerebral blood flow in preterm infants,so that we can better Select the placenta transfusion method.Methods: This trial is a single-center,prospective,double-blind,exploratory randomized controlled clinical trial.From November 2,2018 to November 15,2019,46 preterm infants with gestational age of 30-33 + 6 weeks born at Suining Central Hospital were included and randomly divided into delayed cord clamping group(DCC,n =23)and umbilical cord milking(UCM,n=23).The primary outcome is to compare DCC group and UCM group cerebral blood flow hemodynamic parameter,as peak systolic flow velocity(PSV)、end diastolic velocity(EDV),and resistance index(RI)measured by ultrasound.Patients were followed up to discharge,secondary outcomes such as hematocrit,hemoglobin,red blood cell count,total bilirubin and Intraventricular hemorrhage ratios was collected.The experiment was registered at the China Clinical Trial Center.Registration number:Chi CTR1800018366Results: Forty-six infants recruited at gestational age of 30-33 + 6 weeks were randomly divided into DCC and UCM groups,23 in each group.One infant family member in the DCC group abandoned treatment and one infant diagnosed with trisomy 21 was excluded.DCC(n = 21)and UCM(n = 23)of infants who actually entered statistical analysis.There was no significant difference in baseline characteristics between infants in DCC group and UCM group(p> 0.05).The PSV 、EDV and RI of the DCC group and the UCM group increased with the increase of postnatal age,and the difference was statistically significant(P<0.05).Comparing DCC with UCM,there was no significant difference in PSV、EDV and RI from 30 minutes to 1 hour,24 ± 1 hour,48 ± 1 hour,72 ± 1 hour after birth(P> 0.05).Compared with DCC and UCM,there was no significant difference in hematocrit,hemoglobin,red blood cell count,total bilirubin on the first day after birth,and intraventricular hemorrhage during hospitalization(P> 0.05).Conclusion: There is no difference in the effects of DCC and UCM on cerebral hemodynamics,hematocrit,hemoglobin,red blood cell count,total bilirubin,and intraventricular hemorrhage rates in preterm infants at 30-33 + 6 weeks.For 30-33 + 6weeks preterm infants who who do not need further resuscitation,both DCC or UCM are recommended.