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中华妇幼临床医学杂志(电子版) ›› 2019, Vol. 15 ›› Issue (04) : 363 -367. doi: 10.3877/cma.j.issn.1673-5250.2019.04.002

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延迟断脐对新生儿生理意义的研究现状
钟瑞涵1, 李华凤1,()   
  1. 1. 四川大学华西第二医院麻醉科、出生缺陷与相关妇儿疾病教育部重点实验室,成都 610041
  • 收稿日期:2019-03-08 修回日期:2019-07-04 出版日期:2019-08-01
  • 通信作者: 李华凤

Physiological mechanisms of delayed umbilical cord clamping on neonates: research status

Ruihan Zhong1, Huafeng Li1,()   

  1. 1. Department of Anesthesiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
  • Received:2019-03-08 Revised:2019-07-04 Published:2019-08-01
  • Corresponding author: Huafeng Li
  • About author:
    Corresponding author: Li Huafeng, Email:
  • Supported by:
    National Key Research & Development Program Project(2018YFC2001800); Academic Leader Training Fund Subsidized Project of Science and Technology Department of Sichuan Province(181779); Clinical Research Fund Project of West China Second University Hospital, Sichuan University(Kx086)
引用本文:

钟瑞涵, 李华凤. 延迟断脐对新生儿生理意义的研究现状[J]. 中华妇幼临床医学杂志(电子版), 2019, 15(04): 363-367.

Ruihan Zhong, Huafeng Li. Physiological mechanisms of delayed umbilical cord clamping on neonates: research status[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2019, 15(04): 363-367.

20世纪后,新生儿出生时立即结扎脐带为产科临床上的常规操作。但是,国内外大量研究结果表明,延迟断脐(DCC)可改善新生儿营养状况与健康结局,而且该项技术受到包括世界卫生组织(WHO)在内的多个国际专业机构及组织推荐。目前研究结果表明,DCC有益于新生儿,具有可以增加新生儿血容量、降低其贫血发生率及减少缺血缺氧性脑损伤等并发症发生率等优势。但是,对于DCC的最佳时机及其潜在益处、风险等问题,目前则尚未达成共识。关于DCC对新生儿生理意义的研究,不但可明确DCC的生理机制,还可更新医护人员对断脐时间的传统固有观念,对DCC的临床应用及推广具有积极作用。笔者拟就DCC时间选择、DCC与胎盘输血、DCC与新生儿呼吸功能及DCC对新生儿影响的最新研究现状进行阐述。

After the 20th century, early cord clamping become a routine operation in obstetrics domain. In recent years, however, a large number of studies have shown that delayed cord clamping (DCC) can improve the nutritional status and health outcomes of neonates, and DCC has been recommended by many internationally professional institutions and organizations including World Health Organization (WHO). Current researches indicate that DCC is extremely beneficial to neonates. For example, DCC can increase the blood volume of neonates, reduce the incidence of anemia, and reduce the incidence of complications, such as hypoxic-ischemia brain damage. However, there is no consensus on the optimal timing and other potential benefits and risks of DCC. Studies on the physiological significance of DCC to the neonates can not only confirm the physiological mechanisms of DCC, but also update the traditional concepts of health care staff about the timing of umbilical cord clamping, which contributes to the universal implementation and application of DCC. This article focuses on recent research status of the timing of DCC, DCC and placental transfusion, DCC and respiration functions of newborns, influences on newborns of DCC etc..

[1]
Polglase GR, Blank DA, Barton SK, et al. Physiologically based cord clamping stabilises cardiac output and reduces cerebrovascular injury in asphyxiated near-term lambs[J]. Arch Dis Childhood Fetal Neonat Ed, 2018, 103(6): F530-F538.
[2]
廖伟强. 延迟断脐对新生儿重度窒息预后的影响[J]. 现代医院,2009, 9(10): 30-31.
[3]
Bolstridge J, Bell T, Dean B, et al. A quality improvement initiative for delayed umbilical cord clamping in very low-birthweight infants[J]. BMC Pediatr, 2016, 16(1): 155.
[4]
Boere I, Roest A, Wallace E, et al. Umbilical blood flow patterns directly after birth before delayed cord clamping [J]. Arch Dis Child Fetal Neonatal Ed, 2015, 100(2): F121-F125.
[5]
Perlman JM, Wyllie J, Kattwinkel J. Part 11: neonatal resuscitation: 2010 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations[J]. Circulation, 2010, 122(16): 516-538.
[6]
Sweet DG, Carnielli V, Greisen G, et al. European consensus guidelines on the management of neonatal respiratory distress syndrome in preterm infants--2013 update[J]. Neonatology, 2013, 103(4): 353-368.
[7]
World Health Organization. Guideline: delayed umbilical cord clamping for improved maternal and infant health and nutrition outcomes[R]. Geneva: World Health Organization, 2014.
[8]
Committee on Obstetric Practice. Committee opinion No. 684 summary. Delayed umbilical cord clamping after birth[J]. Obstet Gynecol, 2017, 129(1): e5-e10.
[9]
Hutchon D. Why do obstetricians and midwives still rush to clamp the cord ?[J]. BMJ, 2010, 341: c5447.
[10]
蒋睿,陈海英. 延迟断脐对新生儿影响的研究进展[J]. 护理学杂志,2016, 31(16): 105-108.
[11]
中华医学会围产医学分会,中华护理学会妇产科专业委员会,中国疾病预防控制中心妇幼保健中心. 新生儿早期基本保健技术的临床实施建议(2017年,北京)[J]. 中华围产医学杂志,2017, 20(9): 625-629.
[12]
胡小黎,徐鑫芬,马冬梅. 延迟结扎脐带对新生儿和产妇的影响[J].中华护理杂志,2014, 49 (7): 862-866.
[13]
Vain NE, Satragno DS, Gorenstein AN, et al. Effect of gravity on volume of placental transfusion: a multicentre, randomised, non-inferiority trial[J]. Lancet, 2014, 384(9939): 235-240.
[14]
Crossley KJ, Allison BJ, Polglase GR, et al. Dynamic changes in the direction of blood flow through the ductus arteriosus at birth[J]. J Physiol, 2009, 587(19): 4695-4704.
[15]
Popat H, Robledo KP, Sebastian L, et al. Effect of delayed cord clamping on systemic blood flow: a randomized controlled trial[J]. J Pediatr, 2016, 178: 81.e2-86.e2.
[16]
Yigit MB, Kowalski WJ, Hutchon DJ, et al. Transition from fetal to neonatal circulation: modeling the effect of umbilical cord clamping[J]. J Biomech, 2015, 48(9): 1662-1670.
[17]
Hooper SB, Binder-Heschl C, Polglase GR, et al. The timing of umbilical cord clamping at birth: physiological considerations[J]. Matern Health Neonatol Perinatol, 2016, 2(1): 1-9.
[18]
詹莹. 新生儿心血管系统生理变化的超声研究进展[J]. 中国医师杂志,2013, 15(10): 1426-1429.
[19]
王晓艳,杨国维. 阴道分娩延迟断脐对母儿结局的影响[J]. 现代医学与健康研究,2018, 2(2): 155.
[20]
Hirata M, Kusakawa I, Ohde S, et al. Risk factors of infant anemia in the perinatal period[J]. Pediatr Int, 2017, 59(4): 447-451.
[21]
Andersson O, Lindquist B, Lindgren M, et al. Effect of delayed cord clamping on neurodevelopment at 4 years of age: a randomized clinical trial[J]. JAMA Pediatr, 2015, 169(7): 631-638.
[22]
乔艳梅,杜红丽,刘娜,等. 婴幼儿贫血多因素分析[J]. 临床荟萃,2012, 27(3): 248-249.
[23]
Kc A, Rana N, Malqvist M, et al. Effects of delayed umbilical cord clamping vs early clamping on anemia in infants at 8 and 12 months: a randomized clinical trial[J]. JAMA Pediatr, 2017, 171(3): 264-270.
[24]
Dantas AWC, Farias LJR, de Paula SJ, et al. Nursing diagnosis of neonatal jaundice: study of clinical indicators[J]. J Pediatr Nurs, 2018, 39: e6-e10.
[25]
Rabe H, Diaz-Rossello JL, Duley L, et al. Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes[J]. Cochrane Database Syst Rev, 2012, 12(8): CD003248.
[26]
Carvalho OMC, Augusto MCC, Medeiros MQ, et al. Late umbilical cord clamping does not increase rates of jaundice and the need for phototherapy in pregnancies at normal risk[J]. J Matern Fetal Neonatal Med, 2018, 1: 1-6.
[27]
Polglase GR, Miller SL, Barton SK, et al. Respiratory support for premature neonates in the delivery room: effects on cardiovascular function and the development of brain injury[J]. Pediatr Res, 2014, 75(6): 682-688.
[28]
Katheria A, Garey D, Truong G, et al. A randomized clinical trial of umbilical cord milking vs delayed cord clamping in preterm infants: neurodevelopmental outcomes at 22-26 months of corrected age[J]. J Pediat, 2018, 194(1): 76-80.
[29]
Benziger O, Stolkin F, Keel M. The influence of the timing of cord clamping on postnatal cerebral oxygenation in preterm neonates: a randomized, controlled trial[J]. Pediatrics, 2007, 119(3): 455-459.
[30]
Holman RC, Stoll BJ, Curns AT, et al. Necrotising enterocolitis hospitalisations among neonates in the United States[J]. Paediatr Perinat Epidemiol, 2006, 20(6): 498-506.
[31]
Chiruvolu A, Elliott E, Rich D, et al. Effect of delay in cord clamping 45 versus 60 s on very preterm singleton infants[J]. Early Hum Dev, 2018, 119: 15-18.
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