切换至 "中华医学电子期刊资源库"
高级检索
中华妇幼临床医学杂志(电子版)

中华妇幼临床医学杂志(电子版) ›› 2020, Vol. 16 ›› Issue (04) : 381 -385. doi: 10.3877/cma.j.issn.1673-5250.2020.04.002

所属专题： 文献；

专题论坛

延迟结扎脐带对新生儿的影响
赵晓谈1, 温晓红1,†(), 黄金华1   
  1. 1. 安徽医科大学第三附属医院/合肥市第一人民医院儿科　230061
  • 收稿日期:2020-02-11 修回日期:2020-07-08 出版日期:2020-08-01
  • 通信作者: 温晓红

Effect of delayed cord clamping on neonates

Xiaotan Zhao1, Xiaohong Wen1,†(), Jinhua Huang1   

  1. 1. Department of Pediatrics, the First Affiliated Hospital of Anhui Medical University, Hefei First People′s Hospital, Hefei 230061, Anhui Province, China
  • Received:2020-02-11 Revised:2020-07-08 Published:2020-08-01
  • Corresponding author: Xiaohong Wen
  • About author:
    Corresponding author: Wen Xiaohong, Email:
  • Supported by:
    Program for Science and Technology Development of Anhui Province(1604a0802093)
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

赵晓谈, 温晓红, 黄金华. 延迟结扎脐带对新生儿的影响[J]. 中华妇幼临床医学杂志(电子版), 2020, 16(04): 381-385.

Xiaotan Zhao, Xiaohong Wen, Jinhua Huang. Effect of delayed cord clamping on neonates[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2020, 16(04): 381-385.

新生儿脐带结扎术是胎儿娩出后必要的医疗操作。目前临床上多采取早期结扎脐带(ECC)措施。但是，国内外多项研究结果显示，分娩时采取延迟结扎脐带(DCC)措施，对增加新生儿有效循环血容量、增加血红蛋白及铁储备、降低贫血发生率、改善心血管功能及氧合、增强免疫力等具有显著作用，而且对母儿均无严重不良影响。笔者拟就临床对适宜脐带结扎时间、胎盘输血影响因素、分娩时采取DCC对新生儿的影响及其潜在风险等最新研究进展进行阐述。

关键词: 延迟断脐, 血容量不足, 血液灌注, 血流动力学, 贫血，新生儿, 输血，自体, 时间安排，脐带结扎术, 婴儿，新生

Neonatal ligation of cord is a necessary medical procedure after delivery of fetus. At present, early cord clamping (ECC) is mostly used in clinical practice. However, many results of research at home and abroad show that delayed cord clamping (DCC) can increase effective circulating blood volume of neonates. It has a significant effect on increasing hemoglobin and iron reserve, reducing neonatal anemia, improving cardiovascular function and oxygenation, and enhancing immunity of neonates. No serious adverse effects of DCC on neonates and their mothers have been found. The author intends to elaborate on latest research status of clinical suitable umbilical cord ligation time, influencing factors of placental transfusion, the effect of taking DCC during delivery on neonates and their potential risks.

Key words: Delayed cord clamping, Hypovolemia, Hemoperfusion, Hemodynamics, Anemia, neonatal, Blood transfusion, autologous, Time management, ligation of umbilical cord, Infant, newborn
[1]
Katheria A, Hosono S. A new wrinkle: umbilical cord management (how, when, WHO) [J]. Semin Fetal Neonatal Med, 2018, 23(5): 321-326. DOI: 10.1016/j.siny.2018.07.003.
[2]
萧国良，张春一，张小庄. 延迟结扎脐带对新生儿及婴儿的影响[J/CD]. 中华妇幼临床医学杂志(电子版), 2015, 11(1): 99-101. DOI: 10.3877/cma.j.issn.1673-5250.2015.01.023.
[3]
钟瑞涵，李华凤. 延迟断脐对新生儿生理意义的研究现状[J/CD]. 中华妇幼临床医学杂志(电子版), 2019, 15(4): 363-367. DOI: 10.3877/cma.j.issn.1673-5250.2019.04.002.
[4]
Perlman JM, Wyllie J, Kattwinkel J, et al. Part 7, neonatal resuscitation: 2015 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations [J]. Circulation, 2015, 132(16 Suppl 1): S204-S241. DOI: 10.1161/CIR.0000000000000276.
[5]
McAdams RM, Backes CH, Hutchon DJ. Steps for implementing delayed cord clamping in a hospital setting [J]. Matern Health Neonatol Perinatol, 2015, 1: 10. DOI: 10.1186/s40748-015-0011-8.
[6]
Committee on Obstetric Practice. Committee opinion No. 684: delayed umbilical cord clamping after birth [J]. Obstet Gynecol, 2017, 129(1): e5-e10. DOI: 10.1097/AOG.0000000000001860.
[7]
World Health Organization. Guidelines on basic newborn resuscitation [M]. Geneva: World Health Organization, 2012: 21-24.
[8]
World Health Organization. Guideline: delayed umbilical cord clamping for improved maternal and infant health and nutrition outcomes [M]. Geneva: World Health Organization, 2014: 12-17.
[9]
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. DOI: 10.1016/j.earlhumdev.2018.02.021.
[10]
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: 4. DOI: 10.1186/s40748-016-0032-y.
[11]
Bhatt S, Alison BJ, Wallace EM, et al. Delaying cord clamping until ventilation onset improves cardiovascular function at birth in preterm lambs [J]. J Physiol, 2013, 591(8): 2113-2126. DOI: 10.1113/jphysiol.2012.250084.
[12]
Rabe H, Diazrossello 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, (8): CD003248. DOI: 10.1002/14651858.CD003248.pub3.
[13]
Song D, Jegatheesan P, Desandre G, et al. Duration of cord clamping and neonatal outcomes in very preterm infants [J]. PLoS One, 2015, 10(9): e0138829. DOI: 10.1371/journal.pone.0138829.
[14]
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. DOI: 10.1016/S0140-6736(14)60197-5.
[15]
Stevens GA, Finucane MM, De-Regil LM, et al. Global, regional, and national trends in haemoglobin concentration and prevalence of total and severe anaemia in children and pregnant and non-pregnant women for 1995-2011: a systematic analysis of population-representative data [J]. Lancet Global Health, 2013, 1(1): e16-e25. DOI: 10.1016/S2214-109X(13)70001-9.
[16]
Raju TNK. Timing of umbilical cord clamping after birth for optimizing placental transfusion [J]. Current Opin Pediatr, 2013, 25(2): 180-187. DOI: 10.1097/MOP.0b013e32835d2a9e.
[17]
Kc A, Rana N, Målqvist 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. DOI: 10.1001/jamapediatrics.2016.3971.
[18]
McDonald SJ, Middleton P, Dowswell T, et al. Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes [J]. Evid Based Child Health, 2014, 9(2): 303-397. DOI: 10.1002/ebch.1971.
[19]
Nouraie S, AMIRALIl Akbari S, Vameghi R, et al. The effect of the timing of umbilical cord clamping on hemoglobin levels, neonatal outcomes and developmental status in infants at 4 months old [J]. Iran J Child Neurol, 2019, 13(1): 45-55.
[20]
Askelöf U, Andersson O, Domellöf M, et al. Wait a minute? An observational cohort study comparing iron stores in healthy Swedish infants at 4 months of age after 10-，60- and 180-second umbilical cord clamping [J]. BMJ Open, 2017, 7(12): e017215. DOI: 10.1136/bmjopen-2017-017215.
[21]
Rana N, Kc A, Målqvist M, et al. Effect of delayed cord clamping of term babies on neurodevelopment at 12 months: a randomized controlled trial [J]. Neonatology, 2019, 115(1): 36-42. DOI: 10.1159/000491994.
[22]
Killion MM. Delayed umbilical cord clamping at birth: beneficial for all babies [J]. MCN Am J Matern Child Nurs, 2017, 42(4): 232. DOI: 10.1097/NMC.0000000000000351.
[23]
顾珩，刘春静，纪丽丽，等. 比较胎儿娩出后结扎脐带时机对铁储备的影响[J]. 临床和实验医学杂志，2016, 15(8): 810-812. DOI: 10.3969/j.issn.1671-4695.2016.08.032.
[24]
Niermeyer S. A physiologic approach to cord clamping: clinical issues [J]. Matern Health Neonatol Perinatol, 2015, 1: 21. DOI: 10.1186/s40748-015-0022-5.
[25]
Jelin AC, Zlatnik MG, Kuppermann M, et al. Clamp late and maintain perfusion (CLAMP) policy: delayed cord clamping in preterm infants [J]. J Matern Fetal Neonat Med, 2016, 29(11): 1705-1709. DOI: 10.3109/14767058.2015.1061496.
[26]
Polglase GR, Dawson JA, Kluckow M, et al. Ventilation onset prior to umbilical cord clamping (physiological-based cord clamping) improves systemic and cerebral oxygenationin preterm lambs [J]. PLoS One, 2015, 10(2): e0117504. DOI: 10.1371/journal.pone.0117504.
[27]
Fogarty M, Osborn DA, Askie L. Delayed vs early umbilical cord clamping for preterm infants a systematic review and Meta-analysis [J]. Am J Obstet Gynecol, 2018, 218(1): 1-18. DOI: 10.1016/j.ajog.2017.10.231.
[28]
Menget A, Mougey C, Thiriez G, et al. Advantage of delayed umbilical cord clamping in the newborn infant [J]. Arch Pediatr, 2013, 20(9): 1022-1027. DOI: 10.1016/j.arcped.2013.06.016.
[29]
JAYKKA S. Capillary erection and the structural appearance of fetal and neonatal lungs [J]. Acta Paediatr, 1958, 47(5): 484-500. DOI: 10.1111/j.1651-2227.1958.tb07664.x.
[30]
Wiberg N, Källén K, Olofsson P. Delayed umbilical cord clamping at birth has effects on arterial and venous blood gases and lactate concentrations [J]. BJOG, 2010, 115(6): 697-703. DOI: 10.1111/j.1471-0528.2008.01708.x.
[31]
Chiruvolu A, Qin H, Nguyen ET, et al. The effect of delayed cord clamping on moderate and early late-preterm infants [J]. Am J Perinatol, 2018, 35(3): 286-291. DOI: 10.1055/s-0037-1607222.
[32]
Armanian AM, Tehrani HG, Ansari M, et al. Is " Delayed umbilical cord clamping" beneficial for premature newborns? [J]. Int J Pediatr, 2017, 5(5): 4909-4918. DOI: 10.22038/ijp.2016.7909.
[33]
Vali P, Mathew B, Lakshminrusimha S. Neonatal resuscitation: evolving strategies [J]. Matern Health Neonatol Perinatol, 2015, 1: 4. DOI: 10.1186/s40748-014-0003-0.
[34]
Ceriani JM. Stem cell transfer in newborn infants through placental transfusion via delayed umbilical cord clamping [J]. Arch Argent Pediatr, 2016, 114(6): 498-499. DOI: 10.5546/aap.2016.eng.498.
[35]
Sanberg PR, Park DH, Borlongan CV. Stem cell transplants at childbirth [J]. Stem Cell Rev Rep, 2010, 6(1)：27-30. DOI: 10.1007/s12015-009-9108-7.
[36]
Mercer JS, Vohr BR, Mcgrath MM, et al. Delayed cord clamping in very preterm infants reduces the incidence of intraventricular hemorrhage and late-onset sepsis: a randomized, controlled trial [J]. Pediatrics, 2006, 117(4): 1235-1242. DOI: 10.1542/peds.2005-1706.
[37]
Lawton C, Acosta S, Watson N, et al. Enhancing endogenous stem cells in the newborn via delayed umbilical cord clamping [J]. Neural Regen Res, 2015, 10(9): 1359-1362. DOI: 10.4103/1673-5374.165218.
[38]
Berglund SK, Torres-Espínola FJ, García-Valdés L, et al. The impacts of maternal iron deficiency and being overweight during pregnancy on neurodevelopment of the offspring [J]. Br J Nutr, 2017, 118(7): 533-540. DOI: 10.1017/S0007114517002410.
[39]
Vaivada T, Gaffey MF, Bhutta ZA. Promoting early child development with interventions in health and nutrition: a systematic review [J]. Pediatrics, 2017, 140(2): e20164308. DOI: 10.1542/peds.2016-4308.
[40]
Mercer JS, Erickson-Owens DA, Vohr BR, et al. Effects of placental transfusion on neonatal and 18 month outcomes in preterm infants: a randomized controlled trial [J]. J Pediatr, 2016, 168: 50-55.e1. DOI: 10.1016/j.jpeds.2015.09.068.
[41]
Mercer JS, Erickson-Owens DA, Deoni SCL, et al. Effects of delayed cord clamping on 4-month ferritin levels, brain myelin content, and neurodevelopment: a randomized controlled trial [J]. J Pediatr, 2018, 203: 266-272.e2. DOI: 10.1016/j.jpeds.2018.06.006.
[42]
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. DOI: 10.1001/jamapediatrics.2015.0358.
[43]
QianY, Ying X, Wang P, et al. Early versus delayed umbilical cord clamping on maternal and neonatal outcomes [J]. Arch Gynecol Obstet, 2019, 300(3): 531-543. DOI: 10.1007/s00404-019-05215-8.
[44]
Chen X, Li X, Chang Y, et al. Effect and safety of timing of cord clamping on neonatal hematocrit values and clinical outcomes in term infants: a randomized controlled trial [J]. J Perinatol, 2018, 38(3): 251-257. DOI: 10.1038/s41372-017-0001-y.
[45]
Mercer JS, Erickson-Owens DA, Collins J, et al. Effects of delayed cord clamping on residual placental blood volume, hemoglobin and bilirubin levels in term infants: a randomized controlled trial [J]. J Perinatol, 2017, 37(3): 260-264. DOI: 10.1038/jp.2016.222.
[46]
Zahir F, Rabbani G, Khan RH, et al. The pharmacological features of bilirubin: the question of the century [J]. Cell Mol Biol Lett, 2015, 20(3): 418-447. DOI: 10.1515/cmble-2015-0012.
[47]
Daskalakis G, Papapanagiotou A, Siristatidis C, et al. The influence of delayed cord clamping and cord milking on inflammatory cytokines in umbilical vein and neonatal circulation [J]. Acta Obstet Gynecol Scand, 2018, 97(5): 624-628. DOI: 10.1111/aogs.13294.
[48]
Mohammad K, Tailakh S, Fram K, et al. Effects of early umbilical cord clamping versus delayed clamping on maternal and neonatal outcomes: a Jordanian study [J]. J Matern Fetal Neonatal Med, 2019: 1-7. DOI: 10.1080/14767058.2019.1602603.
[1] 魏淑婕, 惠品晶, 丁亚芳, 张白, 颜燕红, 周鹏, 黄亚波. 单侧颈内动脉闭塞患者行颞浅动脉-大脑中动脉搭桥术的脑血流动力学评估[J]. 中华医学超声杂志（电子版）, 2023, 20(10): 1046-1055.
[2] 董晓燕, 赵琪, 唐军, 张莉, 杨晓燕, 李姣. 奥密克戎变异株感染所致新型冠状病毒感染疾病新生儿的临床特征分析[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(05): 595-603.
[3] 杨莹, 刘艳, 王央丹. 新生儿结节性硬化症相关性癫痫1例并文献复习[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(04): 464-472.
[4] 魏徐, 张鸽, 伍金林. 新生儿脓毒症相关性凝血病的监测和治疗[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(04): 379-386.
[5] 赵金琦, 杨楠, 宫丽霏, 唐玥, 李璐璐, 杨海河, 孔元原. 2011—2020年北京市小于胎龄儿出生状况分析[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(03): 278-286.
[6] 陈玉莲, 刘瀚旻. 人体生命早期呼吸系统菌群与肺部微生物组发育特征及早期菌群稳态研究现状[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(01): 31-37.
[7] 李凤仪, 李若凡, 高旭, 张超凡. 目标导向液体干预对老年胃肠道肿瘤患者术后血流动力学、胃肠功能恢复的影响[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 29-32.
[8] 李晓玉, 江庆, 汤海琴, 罗静枝. 围手术期综合管理对胆总管结石并急性胆管炎患者ERCP +LC术后心肌损伤的影响研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 57-60.
[9] 李祥魁, 薛玉荣, 丁凯, 孔劲松. ESPB、SAPB、TPVB对胸腔镜微创术血流动力学、应激反应的影响[J]. 中华肺部疾病杂志(电子版), 2023, 16(02): 245-247.
[10] 王英, 薛意恒, 刘国勤. 肠系膜下动脉-高位结扎后降乙结肠血流通路重建机制研究方法的探索历程[J]. 中华结直肠疾病电子杂志, 2023, 12(04): 265-271.
[11] 王姗姗, 徐小汝, 史振仙, 张德杰. 丹参多酚酸联合尤瑞克林治疗急性分水岭脑梗死的疗效及对认知功能、脑血流动力学和血清LPA、ox-LDL、MMP-9水平的影响[J]. 中华脑科疾病与康复杂志(电子版), 2023, 13(03): 142-149.
[12] 李田利, 张照龙, 孙成建, 刘国平, 谢宜兴, 赵晓龙, 邵黎明, 郑璇, 王长鑫, 徐锐. 基于血流动力学、血脂及外周血炎症标志物的眼段动脉瘤破裂风险相关研究[J]. 中华消化病与影像杂志(电子版), 2023, 13(02): 78-83.
[13] 陈晓琴, 李星江, 胡涛, 赵金义, 薛培源, 刘伟, 王崇, 胡明成. 椎基底动脉迂曲扩张症的计算流体力学分析[J]. 中华消化病与影像杂志(电子版), 2023, 13(01): 21-25.
[14] 王彦旭, 何益港, 秦永林. 计算流体力学研究B型主动脉夹层中4D Flow MRI的应用进展[J]. 中华介入放射学电子杂志, 2023, 11(02): 159-163.
[15] 强光峰, 孟兰兰, 赵静, 牛峰海, 任雪云. 肺部超声评分对呼吸困难新生儿使用有创机械通气的预测价值[J]. 中华诊断学电子杂志, 2023, 11(02): 104-108.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号