The risk of hyperbilirubinemia in term neonates after placental transfusion — a randomized-blinded controlled trial

Objective: We aimed to demonstrate non-inferiority of delayed cord clamping (DCC) and cord milking (CM) in comparison to early cord clamping (ECC) in the incidence of hyperbilirubinemia requiring phototherapy. Material and methods: 467 of maternal-foetal dyads were screened for eligibility. 389 term infants, of breastfeeding, non-smoking mothers were randomized to receive ECC ( < 40 s), DCC (1–2 min) or CM (4 times towards the neonate). The primary outcome was defined as hyperbilirubinemia requiring phototherapy. Results: 307 patients were included in the analysis. CM did not increase the risk of phototherapy RR 11.27 95% CI (0.80; 2.04). Similar results were achieved when comparing DCC and ECC, RR 1.29 95% CI (0.82; 2.05). This was also true for CM vs DCC, RR 0.99 95% CI (0.64; 1.52). The prevalence of total serum bilirubin (TSB) at 24–48 hours was 10.8 mg/dL; 10.33 mg/dL and 11.39 in ECC, CM and DCC group respectively. Transcutaneous bilirubin (TcB) levels at 24–48 h were 7.58 mg/dL, 7.89 mg/dL and 7.60 mg/dL in the ECC, CM and DCC respectively. None of the neonates met exchange transfusion criteria or symptomatic polycythaemia. Conclusions: Our study suggests that placental transfusion is not associated with hyperbilirubinemia requiring phototherapy or exchange transfusion

Polish growth charts for preterm infants — comparison with reference Fenton charts

Objectives: Proper infant classification, particularly a preterm infant, as small or large for gestational age, is crucial to undertake activities to improve postnatal outcomes. This study aimed to assess the usability of the Fenton preterm growth charts to evaluate the anthropometric parameters of Polish preterm neonates. Material and methods: In this single-center, retrospective study data extracted from the medical documentation of preterm neonates born 2002–2013 were analyzed. Body weight, body length, and head circumference were evaluated and used to develop growth charts, which were compared with the reference Fenton growth charts. Results: This study included 3,205 preterm neonates, of whom 937 were born before 30 weeks of pregnancy. Overall, 11.04%, 3.3%, and 5.2% of neonates were below the 10th percentile on the Fenton charts for birth weight, body length, and head circumference, respectively. Only 26 (6.67%) of 390 analyzed anthropological parameters differed significantly between the study and the Fenton groups. Statistically significant differences between the study and the Fenton populations were found only in body length for both sexes, and in head circumference for female neonates. Conclusions: The growth charts developed in this study for a population of Polish preterm neonates corresponded to the Fenton charts in terms of birth weight but differed in terms of body length and head circumference. Our findings suggest the need to evaluate growth charts for Polish preterm newborns

Use of the expanded Apgar score for the assessment of intraventricular and intraparenchymal haemorrhage risk in neonates

Objectives: Preterm birth is a key factor contributing to haemorrhage incidence in neonates. This study focused on defining relevant parameters for the assessment of intraventricular and intraparenchymal haemorrhage risks in neonates. Material and methods: Chi-square automatic interaction detection was used to analyse the Apgar score (AS), the Apgar max score, and the course of resuscitation documented according to the expanded AS in 696 infants born between 2009 and 2011 in the Neonatal and Intensive Care Department of the Medical University of Warsaw. Results: Gestational age was the most relevant discriminating variable for the prediction of intraventricular III degree and intraparenchymal haemorrhage incidences. Infants born before the 31st week of pregnancy made up 80% of the intraventricular or intraparenchymal haemorrhage cases. Additionally, a fraction of inspired oxygen > 0.8 at ten minutes after birth was a better discriminating variable in the youngest neonates than an Apgar max score ≤ 5, identifying 31.6% and 20.6% of infants with intraventricular and intraparenchymal haemorrhage, respectively. Conclusions: Consideration of the oxygen concentration supplied during resuscitation significantly improves the prognosis of intraventricular and intraparenchymal haemorrhages in preemies compared to the use of the classical AS