Hemodynamics of extremely preterm neonates receiving high vs low oxygen during delayed cord clamping
Background: Delayed cord clamping (DCC) until breathing is established avoids rapid hemodynamic changes and reduces mortality compared to immediate cord clamping, but there has not been a reduction in severe intraventricular hemorrhage (IVH) in extremely preterm neonates. Hypoxic extremely low gestational age newborns (ELGANs) are more likely to have a closed glottis during resuscitation and DCC, preventing adequate lung recruitment. Gap: The benefits of DCC may be augmented by providing supplemental oxygen to prevent glottis closure, optimize non-invasive lung recruitment, and improve pulmonary blood flow and hemodynamic indices. Studies have not shown benefits or reduction in morbidities with the application of ventilation assistance during DCC, but the use of 100% oxygen during DCC has not yet been studied. Hypothesis: We hypothesize that the Hi- O2 group will result in improved hemodynamic indices on early echocardiogram (~ 6 hours of life, HOL). Methods: ELGANs will receive either continuous positive airway pressure or positive pressure ventilation by facemask with FiO2 1.0 or FiO2 of 0.30 during DCC. After DCC the neonate will be resuscitated per the Neonatal Resuscitation Program guidelines. An early echocardiogram will be done at 6 HOL to evaluate hemodynamics using the following indices: right ventricular output, tricuspid annular plane systolic excursion, right ventricular ejection time, pulmonary artery acceleration time, tricuspid regurgitation, pulmonary valve regurgitation, patent ductus arteriosus, left ventricular output, and superior vena cava flow. Results: Pending. Impact: Use of high supplemental oxygen during DCC may reduce hypoxemia, improve lung recruitment, and reduce hemodynamic swings. A comparison of high versus low supplemental oxygen during DCC on hemodynamics and IVH during the early transition period (when most premature infants develop IVH), will help determine if reduced hypoxemia improves long-term neurodevelopmental outcomes.