Elizabeth Foglia, MD, MSCE and Eric Gibson, MD
Is it feasible and safe to initiate resuscitation via intubation and mechanical ventilation prior to umbilical cord clamping in full term infants with congenital diaphragmatic hernia? Dr. Foglia presents reassuring evidence from a recent pilot trial.
Delayed cord clamping has been shown to reduce neonatal morbidities, but is currently not provided to those infants who need immediate resuscitation. Animal studies have shown significant evidence for improved cardiovascular if umbilical cord clamping is postponed until positive pressure ventilation is started. In full term infants with congenital diaphragmatic hernia (CDH), this technique may be beneficial by helping increase aeration and gas exchange prior to cord clamping. Dr. Foglia presents positive findings from a pilot trial designed to assess the feasibility and safety of resuscitation with an intact cord in full term infants with CDH. Preliminary findings indicate that these infants may have a more physiologic sequence after birth that will trigger increase in pulmonary blood flow. Furthermore, the approach is well accepted by mothers. Further studies are needed to determine the impact on relevant clinical outcomes