{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T05:30:07Z","timestamp":1784784607915,"version":"3.55.0"},"reference-count":31,"publisher":"American Medical Association (AMA)","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>An extrauterine placental perfusion (EPP) approach for physiological-based cord clamping (PBCC) may support infants with very low birth weight (VLBW) during transition without delaying measures of support.<\/jats:p><\/jats:sec>Objective<\/jats:title>To test whether EPP in resuscitation of infants with VLBW results in higher hematocrit levels, better oxygenation, or improved infant outcomes compared with delayed cord clamping (DCC).<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This nonblinded, single-center randomized clinical trial was conducted at a tertiary care neonatal intensive care unit. Infants with a gestational age greater than 23 weeks and birth weight less than 1500 g born by cesarean delivery between May 2019 and June 2021 were included. Data were analyzed from October through December 2021.<\/jats:p><\/jats:sec>Intervention<\/jats:title>Prior to cesarean delivery, participants were allocated to receive EPP or DCC. In the EPP group, infant and placenta, connected by an intact umbilical cord, were detached from the uterus and transferred to the resuscitation unit. Respiratory support was initiated while holding the placenta over the infant. The umbilical cord was clamped when infants showed regular spontaneous breathing, stable heart rates greater than 100 beats\/min, and adequate oxygen saturations. In the DCC group, cords were clamped 30 to 60 seconds after birth before infants were transferred to the resuscitation unit, where respiratory support was started.<\/jats:p><\/jats:sec>Main Outcomes and Measure<\/jats:title>The primary outcome was the mean hematocrit level in the first 24 hours after birth. Secondary prespecified outcome parameters comprised oxygenation during transition and short-term neonatal outcome.<\/jats:p><\/jats:sec>Results<\/jats:title>Among 60 infants randomized and included, 1 infant was excluded after randomization; there were 29 infants in the EPP group (mean [SD] gestational age, 27 weeks 6 days [15.0 days]; 14 females [48.3%]) and 30 infants in the DCC group (mean [SD] gestational age, 28 weeks 1 day [17.1 days]; 17 females [56.7%]). The mean (SD) birth weight was 982.8 (276.6) g and 970.2 (323.0) g in the EPP and DCC group, respectively. Intention-to-treat analysis revealed no significant difference in mean hematocrit level (mean difference [MD], 2.1 percentage points; [95% CI, \u22122.2 to 6.4 percentage points]). During transition, infants in the EPP group had significantly higher peripheral oxygen saturation as measured by pulse oximetry (adjusted MD at 5 minutes, 15.3 percentage points [95% CI, 2.0 to 28.6 percentage points]) and regional cerebral oxygen saturation (adjusted MD at 5 minutes, 11.3 percentage points [95% CI, 2.0 to 20.6 percentage points]). Neonatal outcome parameters were similar in the 2 groups.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>This study found that EPP resulted in similar hematocrit levels as DCC, with improved cerebral and peripheral oxygenation during transition. These findings suggest that EPP may be an alternative procedure for PBCC in infants with VLBW.<\/jats:p><\/jats:sec>Trial Registration<\/jats:title>ClinicalTrials.gov Identifier: NCT03916159<\/jats:ext-link><\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2023.40597","type":"journal-article","created":{"date-parts":[[2023,11,3]],"date-time":"2023-11-03T15:31:03Z","timestamp":1699025463000},"page":"e2340597","source":"Crossref","is-referenced-by-count":22,"title":["Extrauterine Placental Perfusion and Oxygenation in Infants With Very Low Birth Weight"],"prefix":"10.1001","volume":"6","author":[{"given":"Benjamin","family":"Kuehne","sequence":"first","affiliation":[{"name":"Division of Neonatology, Department of Pediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Berthold","family":"Gr\u00fcttner","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Hellmich","sequence":"additional","affiliation":[{"name":"Institute of Medical Statistics and Computational Biology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Hero","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Kribs","sequence":"additional","affiliation":[{"name":"Division of Neonatology, Department of Pediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andr\u00e9","family":"Oberthuer","sequence":"additional","affiliation":[{"name":"Division of Neonatology, Department of Pediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2023,11,3]]},"reference":[{"key":"zoi231182r1","doi-asserted-by":"publisher","first-page":"291","DOI":"10.1016\/j.resuscitation.2021.02.014","article-title":"European Resuscitation Council Guidelines 2021: newborn resuscitation and support of transition of infants at birth.","volume":"161","author":"Madar","year":"2021","journal-title":"Resuscitation"},{"key":"zoi231182r2","doi-asserted-by":"publisher","first-page":"A156","DOI":"10.1016\/j.resuscitation.2020.09.015","article-title":"Neonatal Life Support 2020 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations.","volume":"156","author":"Wyckoff","year":"2020","journal-title":"Resuscitation"},{"issue":"9","key":"zoi231182r3","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD003248.pub4","article-title":"Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes.","volume":"9","author":"Rabe","year":"2019","journal-title":"Cochrane Database Syst Rev"},{"issue":"3","key":"zoi231182r4","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2020-0576","article-title":"Umbilical cord management for newborns <34 weeks\u2019 gestation: a meta-analysis.","volume":"147","author":"Seidler","year":"2021","journal-title":"Pediatrics"},{"issue":"3","key":"zoi231182r5","doi-asserted-by":"publisher","first-page":"150","DOI":"10.1016\/S2352-4642(21)00373-4","article-title":"Effects of delayed versus immediate umbilical cord clamping in reducing death or major disability at 2 years corrected age among very preterm infants (APTS): a multicentre, randomised clinical trial.","volume":";6","author":"Robledo","year":"2022","journal-title":"Lancet Child Adolesc Health"},{"issue":"5","key":"zoi231182r6","doi-asserted-by":"publisher","first-page":"608","DOI":"10.1038\/pr.2015.21","article-title":"Cardiovascular transition at birth: a physiological sequence.","volume":"77","author":"Hooper","year":"2015","journal-title":"Pediatr Res"},{"issue":"8","key":"zoi231182r7","doi-asserted-by":"publisher","first-page":"2113","DOI":"10.1113\/jphysiol.2012.250084","article-title":"Delaying cord clamping until ventilation onset improves cardiovascular function at birth in preterm lambs.","volume":"591","author":"Bhatt","year":"2013","journal-title":"J Physiol"},{"issue":"2","key":"zoi231182r8","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1038\/jp.2016.151","article-title":"Placental transfusion: a review.","volume":"37","author":"Katheria","year":"2017","journal-title":"J Perinatol"},{"issue":"4","key":"zoi231182r9","doi-asserted-by":"publisher","first-page":"432","DOI":"10.1159\/000499361","article-title":"European consensus guidelines on the management of respiratory distress syndrome\u20142019 update.","volume":"115","author":"Sweet","year":"2019","journal-title":"Neonatology"},{"issue":"7","key":"zoi231182r10","doi-asserted-by":"publisher","first-page":"1540","DOI":"10.1038\/s41372-021-01052-3","article-title":"A review of different resuscitation platforms during delayed cord clamping.","volume":"41","author":"Katheria","year":"2021","journal-title":"J Perinatol"},{"issue":"2","key":"zoi231182r11","first-page":"1","article-title":"The importance of the umbilical circulation in preventing respiratory distress syndrome following premature caesarean delivery, 1957 \u2013 1973.","volume":"116","author":"Dunn","year":"2017","journal-title":"West Engl Med J"},{"issue":"1","key":"zoi231182r12","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1111\/jmwh.v65.1","article-title":"Implementing delayed umbilical cord clamping in cesarean birth using a novel method: a pilot study of feasibility and safety.","volume":"65","author":"Welsh","year":"2020","journal-title":"J Midwifery Womens Health"},{"issue":"2","key":"zoi231182r13","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1159\/000488926","article-title":"Mask continuous positive airway pressure therapy with simultaneous extrauterine placental transfusion for resuscitation of preterm infants\u2014a preliminary study.","volume":"3","author":"Kuehne","year":"2018","journal-title":"Biomed Hub"},{"issue":"12","key":"zoi231182r14","doi-asserted-by":"publisher","first-page":"1232","DOI":"10.1111\/apa.2012.101.issue-12","article-title":"Outcome of extremely low gestational age newborns after introduction of a revised protocol to assist preterm infants in their transition to extrauterine life.","volume":"101","author":"Mehler","year":"2012","journal-title":"Acta Paediatr"},{"issue":"1","key":"zoi231182r15","doi-asserted-by":"publisher","first-page":"F102","DOI":"10.1136\/archdischild-2018-314898","article-title":"Supporting breathing of preterm infants at birth: a narrative review.","volume":"104","author":"Martherus","year":"2019","journal-title":"Arch Dis Child Fetal Neonatal Ed"},{"key":"zoi231182r16","doi-asserted-by":"publisher","first-page":"3","DOI":"10.3389\/fped.2019.00003","article-title":"Comparison of two respiratory support strategies for stabilization of very preterm infants at birth: a matched-pairs analysis.","volume":"7","author":"Martherus","year":"2019","journal-title":"Front Pediatr"},{"issue":"6","key":"zoi231182r17","doi-asserted-by":"publisher","first-page":"e1340","DOI":"10.1542\/peds.2009-1510","article-title":"Defining the reference range for oxygen saturation for infants after birth.","volume":"125","author":"Dawson","year":"2010","journal-title":"Pediatrics"},{"issue":"2","key":"zoi231182r18","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1016\/j.jbi.2008.08.010","article-title":"Research electronic data capture (REDCap)\u2013a metadata-driven methodology and workflow process for providing translational research informatics support.","volume":"42","author":"Harris","year":"2009","journal-title":"J Biomed Inform"},{"key":"zoi231182r19","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2019.103208","article-title":"The REDCap consortium: building an international community of software platform partners.","volume":"95","author":"Harris","year":"2019","journal-title":"J Biomed Inform"},{"issue":"5","key":"zoi231182r20","doi-asserted-by":"publisher","first-page":"1305","DOI":"10.1542\/peds.2004-0204","article-title":"Impact of a physiologic definition on bronchopulmonary dysplasia rates.","volume":"114","author":"Walsh","year":"2004","journal-title":"Pediatrics"},{"key":"zoi231182r21","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1016\/j.jpeds.2016.07.053","article-title":"Neonatal resuscitation with an intact cord: a randomized clinical trial.","volume":"178","author":"Katheria","year":"2016","journal-title":"J Pediatr"},{"issue":"1","key":"zoi231182r22","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1542\/peds.2004-1773","article-title":"Infants\u2019 blood volume in a controlled trial of placental transfusion at preterm delivery.","volume":"117","author":"Aladangady","year":"2006","journal-title":"Pediatrics"},{"issue":"Suppl 1","key":"zoi231182r23","doi-asserted-by":"publisher","first-page":"S68","DOI":"10.1038\/jp.2010.186","article-title":"Effects of delayed cord clamping in very-low-birth-weight infants.","volume":"31 Suppl 1","author":"Oh","year":"2011","journal-title":"J Perinatol"},{"key":"zoi231182r24","doi-asserted-by":"publisher","DOI":"10.1111\/jog.v46.12","article-title":"Umbilical cord management strategies at cesarean section.","author":"Consonni","year":"2020","journal-title":"J Obstet Gynaecol Res"},{"key":"zoi231182r25","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2022.925656","article-title":"Effects of spontaneous first breath on placental transfusion in term neonates born by cesarean section: a randomized controlled trial.","volume":"10","author":"Kilicdag","year":"2022","journal-title":"Front Pediatr"},{"issue":"2","key":"zoi231182r26","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0117504","article-title":"Ventilation onset prior to umbilical cord clamping (physiological-based cord clamping) improves systemic and cerebral oxygenation in preterm lambs.","volume":"10","author":"Polglase","year":"2015","journal-title":"PLoS One"},{"issue":"4","key":"zoi231182r27","doi-asserted-by":"publisher","first-page":"F396","DOI":"10.1136\/archdischild-2018-315483","article-title":"Physiological-based cord clamping in preterm infants using a new purpose-built resuscitation table: a feasibility study.","volume":"104","author":"Brouwer","year":"2019","journal-title":"Arch Dis Child Fetal Neonatal Ed"},{"issue":"5","key":"zoi231182r28","doi-asserted-by":"publisher","first-page":"F422","DOI":"10.1136\/archdischild-2014-307590","article-title":"Cerebral haemorrhage in preterm neonates: does cerebral regional oxygen saturation during the immediate transition matter?","volume":"100","author":"Baik","year":"2015","journal-title":"Arch Dis Child Fetal Neonatal Ed"},{"key":"zoi231182r29","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1016\/j.jpeds.2020.07.045","article-title":"Delayed vs immediate cord clamping changes oxygen saturation and heart rate patterns in the first minutes after birth.","volume":"227","author":"Padilla-S\u00e1nchez","year":"2020","journal-title":"J Pediatr"},{"issue":"4","key":"zoi231182r30","doi-asserted-by":"publisher","first-page":"60","DOI":"10.3390\/children6040060","article-title":"Neonatal resuscitation with an intact cord: current and ongoing trials.","volume":"6","author":"Katheria","year":"2019","journal-title":"Children (Basel)"},{"key":"zoi231182r31","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1016\/j.ejogrb.2021.06.041","article-title":"Timing of umbilical cord clamping for preterm infants in low-and-middle-income countries: a survey of current practice.","volume":"264","author":"Payne","year":"2021","journal-title":"Eur J Obstet Gynecol Reprod Biol"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2811323\/kuehne_2023_oi_231182_1698176569.85655.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,3]],"date-time":"2023-11-03T15:31:06Z","timestamp":1699025466000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2811323"}},"subtitle":["A Randomized Clinical Trial"],"short-title":[],"issued":{"date-parts":[[2023,11,3]]},"references-count":31,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2023,11,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2023.40597","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11,3]]}}}