Placental Transfusion, Timing of Plastic Wrap or Bag Placement, and Preterm Neonates

Abstract

Objective Compare delivery room practices and outcomes of infants born at less than 32 weeks' gestation or less than 1,500 g who have plastic wrap/bag placement simultaneously during placental transfusion to those receiving plastic wrap/bag placement sequentially following placental transfusion.

Study Design Retrospective analysis of data from a multisite quality improvement initiative to refine stabilization procedures pertaining to placental transfusion and thermoregulation using a plastic wrap/bag. Delivery room practices and outcome data in 590 total cases receiving placental transfusion were controlled for propensity score matching and hospital of birth.

Results The simultaneous and sequential groups were similar in demographic and most outcome metrics. The simultaneous group had longer duration of delayed cord clamping compared with the sequential group (42.3 ± 14.8 vs. 34.1 ± 10.3 seconds, p < 0.001), and fewer number of times cord milking was performed (0.41 ± 1.26 vs. 0.86 ± 1.92 seconds, p < 0.001). The time to initiate respiratory support was also significantly shorter in the simultaneous group (97.2 ± 100.6 vs. 125.2 ± 177.6 seconds, p = 0.02). The combined outcome of death or necrotizing enterocolitis in the simultaneous group was more frequent than in the sequential group (15.3 vs. 9.3%, p = 0.038); all other outcomes measured were similar.

Conclusion Timing of plastic wrap/bag placement during placental transfusion did affect duration of delayed cord clamping, number of times cord milking was performed, and time to initiate respiratory support in the delivery room but did not alter birth hospital outcomes or respiratory care practices other than the combined outcome of death or necrotizing enterocolitis.

Key Points

• Plastic bag placement during placental transfusion is effective in stabilization of preterms.

• Plastic bag placement after placental transfusion is effective in stabilization of preterms.

• Plastic bag placement during placental transfusion and risk of death or necrotizing enterocolitis needs additional study.

Keywords

plastic wrap or bag placement - placental transfusion - delayed cord clamping - umbilical cord milking - prematurity - thermoregulation - neonatal resuscitation - plastic wrap - plastic bag - necrotizing enterocolitis - mortality

Note

The outcomes of plastic wrap/bag placement simultaneously during or sequentially following placental transfusion in preterm neonates are compared.

Authors' Contributions

W.E. designed the project, drafted the initial manuscript, and reviewed and revised the manuscript. I.L. conceived and designed this project and participated in acquisition, analysis, and interpretation of data. B.B., A.B., M.K., W.B., S.W., S.H., R.C., A.S., B.B., P.W., V.G., M.S., C.P., and J.J. participated in acquisition, analysis, and interpretation of data. J.S.T. designed and managed the data acquisition tool and participated in analysis and interpretation of data. T.H. designed the statistical analysis and participated in data analysis and interpretation. All authors approved of the final manuscript as submitted and agree to be accountable for all aspects of the work.

Publication History

Received: 02 March 2021

Accepted: 26 April 2021

Article published online:
12 July 2021

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