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中华妇幼临床医学杂志(电子版) ›› 2022, Vol. 18 ›› Issue (04) : 393 -399. doi: 10.3877/cma.j.issn.1673-5250.2022.04.004

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胎盘输血技术发展现状
悦光, 卢江溢, 周小凤, 王倩颖, 巨容()   
  1. 电子科技大学医学院附属妇女儿童医院·成都市妇女儿童中心医院新生儿科,成都 611731
  • 收稿日期:2022-01-30 修回日期:2022-07-13 出版日期:2022-08-01
  • 通信作者: 巨容

Current research status of placental transfusion

Guang Yue, Jiangyi Lu, Xiaofeng Zhou, Qianying Wang, Rong Ju()   

  1. Department of Neonatology, Chengdu Women′s and Children′s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu 611731, Sichuan Province, China
  • Received:2022-01-30 Revised:2022-07-13 Published:2022-08-01
  • Corresponding author: Rong Ju
  • Supported by:
    Popularization Application Project of Health Commission of Sichuan Province(18PJ046)
引用本文:

悦光, 卢江溢, 周小凤, 王倩颖, 巨容. 胎盘输血技术发展现状[J]. 中华妇幼临床医学杂志(电子版), 2022, 18(04): 393-399.

Guang Yue, Jiangyi Lu, Xiaofeng Zhou, Qianying Wang, Rong Ju. Current research status of placental transfusion[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2022, 18(04): 393-399.

胎盘输血对新生儿的益处已得到广泛证实,既可以补充新生儿血容量,改善生后早期脏器灌注,有利于胎儿血循环向新生儿血循环过渡,也可以减少输血治疗需求,促进新生儿出生时建立适应的生理机制和功能,降低新生儿颅内出血(ICH)、坏死性小肠结肠炎、支气管肺发育不良等并发症发生率。同时,还可增加新生儿血清铁储备,改善神经系统疾病新生儿远期预后,降低新生儿死亡率。本文涉及的胎盘输血措施主要包括新生儿分娩时采取延迟脐带结扎(DCC)和脐带挤压(UCM)。根据世界卫生组织等权威机构推荐,对多数有活力足月新生儿和早产儿应采取DCC措施,达到胎盘输血的目的。笔者拟对胎盘输血的:①生理学基础;②对新生儿影响;③当前对其研究的重点方向等最新研究现状进行阐述。

The multiple benefits of placental transfusion for neonates have been widely confirmed. This procedure can replenish blood volume, improve organ perfusion in the early postnatal stage, facilitate the transition from fetal to neonatal circulation. Placental transfusion can reduce the demand for blood transfusion, promote the physiological mechanism and function of neonatal adaptation at birth, and the onset of intracranial hemorrhage (ICH), necrotizing enterocolitis, bronchopulmonary dysplasia and other complications. It can also improve serum iron reserve and long-term prognosis of central nervous system, and reduce infant mortality. Placental transfusion in this article consists of delayed cord clamping (DCC) and umbilical cord milking (UCM). Routine use of DCC at birth for most vigorous term or preterm infants is recommended by World Health Organization. The author intends to expound on physiological basis of placental transfusion, effects of placental transfusion on neonates, and key directions of current research of placental transfusion.

[1]
中国医师协会新生儿科医师分会,中国妇幼保健协会新生儿保健专业委员会,《发育医学电子杂志》编辑委员会. 胎盘输血专家共识[J]. 发育医学电子杂志2021, 9(4): 241-247. DOI: 10.3969/j.issn.2095-5340.2021.04.001.
[2]
赵晓谈,温晓红,黄金华. 延迟结扎脐带对新生儿的影响[J/OL]. 中华妇幼临床医学杂志(电子版), 2020, 16(4): 381-385. DOI: 10.3877/cma.j.issn.1673-5250.2020.04.002.
[3]
World Health Organization. Guidelines on basic newborn resuscitation[EB/OL]. (2020-04-11)[2022-04-10].

URL    
[4]
Committee opinion No. 684: delayed umbilical cord clamping after birth[J]. Obstet Gynecol, 2017, 129(1): 1. DOI: 10.1097/AOG.0000000000001860.
[5]
Delayed umbilical cord clamping after birth[J]. Pediatrics, 2017, 139(6): e20170957. DOI: 10.1542/peds.2017-0957.
[6]
钟瑞涵,李华凤. 延迟断脐对新生儿生理意义的研究现状[J/OL]. 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.
[7]
Polin RA, Abman SH, Rowitch DH, et al. Fetal and neonatal physiology[M]. 5th ed. Philadelphia: Elsevier Inc., 2017. DOI: 10.1016/c2013-1-00433-7.
[8]
Ghirardello S, Di Tommaso M, Fiocchi S, et al. Italian recommendations for placental transfusion strategies[J]. Front Pediatr, 2018, 6, 372. DOI: 10.3389/fped.2018.00372.
[9]
Katheria AC, Lakshminrusimha S, Rabe H, et al. Placental transfusion: a review[J]. J Perinatol, 2017, 37(2): 105-111. DOI: 10.1038/jp.2016.151.
[10]
Dupont TL, Ohls RK. Placental transfusion: current practices and future directions[J]. Neoreviews, 2018, 19(1): e1-e10. DOI: 10.1542/neo.19-1-e1.
[11]
Andersson O, Hellström-Westas L, Andersson D, et al. Effect of delayed versus early umbilical cord clamping on neonatal outcomes and iron status at 4 months: a randomised controlled trial[J]. BMJ, 2011, 343: d7157. DOI: 10.1136/bmj.d7157.
[12]
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.
[13]
Kirby E, Keijzer R. Congenital diaphragmatic hernia: current management strategies from antenatal diagnosis to long-term follow-up[J]. Pediatr Surg Int, 2020, 36(4): 415-429. DOI: 10.1007/s00383-020-04625-z.
[14]
Clinical Trials. Delayed cord clamping for intubation and gentle ventilation in infants with congenital diaphragmatic hernia: a pilot feasibility trial[EB/OL]. (2022-04-05)[2022-04-10].

URL    
[15]
Marzec L, Zettler E, Cua CL, et al. Timing of umbilical cord clamping among infants with congenital heart disease[J]. Prog Pediatr Cardiol, 2020, 59: 101318. DOI: 10.1016/j.ppedcard.2020.101318.
[16]
Jain R, Jain A, Devgan V, et al. Effect of alternative positions of neonates prior to delayed cord clamping on placental transfusion: a randomized control trial[J]. J Matern Fetal Neonatal Med, 2020, 33(9): 1511-1516. DOI: 10.1080/14767058.2018.1520834.
[17]
Aziz K, Lee CHC, Escobedo MB, et al. Part 5: Neonatal resuscitation 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care[J]. Pediatrics, 2021, 147(Suppl 1): e2020038505E. DOI: 10.1542/peds.2020-038505E.
[18]
Rabe H, Gyte GM, Díaz-Rossello JL, 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, 2019, 9(9): CD003248. DOI: 10.1002/14651858.CD003248.pub4.
[19]
de Waal K, Kluckow M. Superior vena cava flow: role, assessment and controversies in the management of perinatal perfusion[J]. Semin Fetal Neonatal Med, 2020, 25(5): 101122. DOI: 10.1016/j.siny.2020.101122.
[20]
Katheria A, Lee HC, Knol R, et al. A review of different resuscitation platforms during delayed cord clamping[J]. J Perinatol, 2021, 41(7): 1540-1548. DOI: 10.1038/s41372-021-01052-3.
[21]
Meyer MP, Nevill E, Wong MM. Provision of respiratory support compared to no respiratory support before cord clamping for preterm infants[J]. Cochrane Database Syst Rev, 2018, 3(3): CD012491. DOI: 10.1002/14651858.CD012491.pub2.
[22]
Nagy M, Nasef N, Gibreel A, et al. Impact of umbilical cord milking on hematological parameters in preterm neonates with placental insufficiency[J]. Front Pediatr, 2022, 9: 827219. DOI: 10.3389/fped.2021.827219.
[23]
Nagano N, Saito M, Sugiura T, et al. Benefits of umbilical cord milking versus delayed cord clamping on neonatal outcomes in preterm infants: a systematic review and Meta-analysis[J]. PLoS One, 2018, 13(8): e0201528. DOI: 10.1371/journal.pone.0201528.
[24]
Shirk SK, Manolis SA, Lambers DS, et al. Delayed clamping vs milking of umbilical cord in preterm infants: a randomized controlled trial[J]. Am J Obstet Gynecol, 2019, 220(5): 482.e1-482.e8. DOI: 10.1016/j.ajog.2019.01.234.
[25]
Hosono S, Mugishima H, Takahashi S, et al. One-time umbilical cord milking after cord cutting has same effectiveness as multiple-time umbilical cord milking in infants born at<29 weeks of gestation: a retrospective study[J]. J Perinatol, 2015, 35(8): 590-594. DOI: 10.1038/jp.2015.15.
[26]
Yue G, Wu Y, Zhao F, et al. A 3-armed multicenter randomized controlled trial: placental transfusion in very preterm infants (PT-VPI)[J]. Contemp Clin Trials, 2021, 103: 106337. DOI: 10.1016/j.cct.2021.106337.
[27]
Christensen RD, Baer VL, Gerday E, et al. Whole-blood viscosity in the neonate: effects of gestational age, hematocrit, mean corpuscular volume and umbilical cord milking[J]. J Perinatol, 2014, 34(1): 16-21. DOI: 10.1038/jp.2013.112.
[28]
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.
[29]
Chaowawanit W, Koovimon P, Soongsatitanon A. The residual blood from segmental umbilical cord milking in preterm delivery[J]. J Obstet Gynaecol, 2020, 40(2): 205-210. DOI: 10.1080/01443615.2019.1621812.
[30]
Zur RL, Kingdom JC, Parks WT, et al. The placental basis of fetal growth restriction[J]. Obstet Gynecol Clin North Am, 2020, 47(1): 81-98. DOI: 10.1016/j.ogc.2019.10.008.
[31]
Digal KC, Singh P, Srivastava Y, et al. Effects of delayed cord clamping in intrauterine growth-restricted neonates: a randomized controlled trial[J]. Eur J Pediatr, 2021, 180(6): 1701-1710. DOI: 10.1007/s00431-021-03959-7.
[32]
战军,邢爱耘,廖光东,等. 多胎妊娠延迟分娩的研究现状[J/OL]. 中华妇幼临床医学杂志(电子版), 2020, 16(2): 155-160. DOI: 10.3877/cma.j.issn.1673-5250.2020.02.006.
[33]
Ghirardello S, Crippa BL, Cortesi V, et al. Delayed cord clamping increased the need for phototherapy treatment in infants with ABO alloimmunization born by cesarean section: a retrospective study[J]. Front Pediatr, 2018, 6: 241. DOI: 10.3389/fped.2018.00241.
[34]
Jung E, Romero R, Yeo L, et al. The fetal inflammatory response syndrome: the origins of a concept, pathophysiology, diagnosis, and obstetrical implications[J]. Semin Fetal Neonatal Med, 2020, 25(4): 101146. DOI: 10.1016/j.siny.2020.101146.
[35]
Panel on Treatment of Pregnant Women with HIV Infection and Prevention of Perinatal Transmission. Recommendations for the use of antiretroviral drugs in pregnant women with HIV infection and interventions to reduce perinatal HIV transmission in the United States[DB/OL]. Rockville: Department of Health and Human Services, 2021[2022-03-10].

URL    
[36]
Pogliani L, Erba P, Nannini P, et al. Effects and safety of delayed versus early umbilical cord clamping in newborns of HIV-infected mothers[J]. J Matern Fetal Neonatal Med, 2019, 32(4): 646-649. DOI: 10.1080/14767058.2017.1387896.
[37]
Committee on Obstetric Practice, HIV Expert Work Group. ACOG Committee Opinion No. 751: labor and delivery management of women with human immunodeficiency virus infection[J]. Obstet Gynecol, 2018, 132(3): e131-e137. DOI: 10.1097/AOG.0000000000002820.
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