Tina Perme, Lilijana Kornhauser Cerar, Bernhard Schwaberger, Berndt Urlesberger, Christina Helene Wolfsberger, Nariae Baik, Katharina Goeral, Marlene Hammerl, Eugene M Dempsey, Laila Springer, Gianluca Lista, Tomasz Szczapa, Hans Fuchs, Lukasz Karpinski, Jenny Bua, Alexander Avian, Brenda Hiu Yan Law, Julia Buchmayer, Ursula Kiechl-Kohlendorfer, Christoph E Schwarz, Kerstin Gruendler, Ilaria Stucchi, Katrin Klebermass-Schrehof, Georg M Schmölzer, Gerhard Pichler
{"title":"脐带夹紧时间对大脑区域组织氧合的影响：COSGOD III试验的二次分析。","authors":"Tina Perme, Lilijana Kornhauser Cerar, Bernhard Schwaberger, Berndt Urlesberger, Christina Helene Wolfsberger, Nariae Baik, Katharina Goeral, Marlene Hammerl, Eugene M Dempsey, Laila Springer, Gianluca Lista, Tomasz Szczapa, Hans Fuchs, Lukasz Karpinski, Jenny Bua, Alexander Avian, Brenda Hiu Yan Law, Julia Buchmayer, Ursula Kiechl-Kohlendorfer, Christoph E Schwarz, Kerstin Gruendler, Ilaria Stucchi, Katrin Klebermass-Schrehof, Georg M Schmölzer, Gerhard Pichler","doi":"10.1136/archdischild-2024-327946","DOIUrl":null,"url":null,"abstract":"<p><strong>Aim: </strong>To determine how different cord clamping strategies affect cerebral oxygenation in the first 15 min after birth in preterm infants.</p><p><strong>Methods: </strong>A post-hoc secondary outcome analysis of a multicentre prospective randomised clinical trial (COSGOD III) conducted between October 2017 and October 2021 in 11 tertiary neonatal intensive care units in six countries in Europe and in Canada. In the present ancillary study, all included premature neonates (<32 weeks gestation) were retrospectively assigned to three groups according to the timing of cord clamping (G1<30 s, G2 30-60 s, G3>30 s). The aim of this study was to evaluate differences in cerebral regional oxygen saturation (crSO<sub>2</sub>) and cerebral fractional tissue oxygen extraction (cFTOE) within the first 15 min after birth in preterm neonates based on the timing of cord clamping.</p><p><strong>Results: </strong>572 infants (n=339 (G1), n=164 (G2) and n=69 (G3)) were included in the final ancillary analysis. There were no statistically significant differences in crSO<sub>2</sub> and cFTOE between the three groups. 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引用次数: 0
摘要
目的：探讨不同脐带夹紧策略对早产儿出生后15分钟脑氧合的影响。方法：对2017年10月至2021年10月在欧洲和加拿大6个国家的11个三级新生儿重症监护室进行的一项多中心前瞻性随机临床试验（COSGOD III）进行事后次要结局分析。在本辅助研究中，所有纳入早产儿（30岁）。本研究的目的是评估早产儿出生后15分钟内基于脐带夹紧时间的脑区域氧饱和度（crSO2）和脑组织分数氧提取（cFTOE）的差异。结果：572名婴儿(n=339 (G1), n=164 （G2), n=69 (G3)）被纳入最终的辅助分析。三组间crSO2、cFTOE差异无统计学意义。在新生儿发病率方面，三组之间没有统计学上的显著差异，特别是在脑损伤程度方面，以任何程度的脑室内出血或囊性脑室周围白质软化来衡量。结论：新生儿出生后15 min crSO2和cFTOE无显著差异；然而，在干预组中，一些效果可能已经被方案指导的补充氧滴定所改变。因此，在我们的研究中，我们没有发现延迟脐带夹紧与出生后立即改善脑氧合之间的相关性。试验注册号：NCT03166722。
Effect of timing of umbilical cord clamping on cerebral regional tissue oxygenation: a secondary analysis of the COSGOD III trial.
Aim: To determine how different cord clamping strategies affect cerebral oxygenation in the first 15 min after birth in preterm infants.
Methods: A post-hoc secondary outcome analysis of a multicentre prospective randomised clinical trial (COSGOD III) conducted between October 2017 and October 2021 in 11 tertiary neonatal intensive care units in six countries in Europe and in Canada. In the present ancillary study, all included premature neonates (<32 weeks gestation) were retrospectively assigned to three groups according to the timing of cord clamping (G1<30 s, G2 30-60 s, G3>30 s). The aim of this study was to evaluate differences in cerebral regional oxygen saturation (crSO2) and cerebral fractional tissue oxygen extraction (cFTOE) within the first 15 min after birth in preterm neonates based on the timing of cord clamping.
Results: 572 infants (n=339 (G1), n=164 (G2) and n=69 (G3)) were included in the final ancillary analysis. There were no statistically significant differences in crSO2 and cFTOE between the three groups. There were no statistically significant differences between the three groups in neonatal morbidities, particularly importantly in the degree of cerebral injury, as measured by any degree of intraventricular haemorrhage or cystic periventricular leukomalacia.
Conclusions: No significant differences in crSO2 and cFTOE during the first 15 min after birth were observed; however, some effect may have been modified by protocol-guided titration of supplemental oxygen in the intervention arm. Thus, in our study, we did not find a correlation between deferred cord clamping and improved cerebral oxygenation immediately after birth.
期刊介绍：
Archives of Disease in Childhood is an international peer review journal that aims to keep paediatricians and others up to date with advances in the diagnosis and treatment of childhood diseases as well as advocacy issues such as child protection. It focuses on all aspects of child health and disease from the perinatal period (in the Fetal and Neonatal edition) through to adolescence. ADC includes original research reports, commentaries, reviews of clinical and policy issues, and evidence reports. Areas covered include: community child health, public health, epidemiology, acute paediatrics, advocacy, and ethics.
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