Timing of cord clamping in relation to start of XXXX or ventilation among depressed neonates-an observational study.

@entity1 @entity204 @entity2286 @entity1353
OBJECTIVES: The optimal timing of cord clamping (CC) in nonbreathing neonates needing stabilisation/resuscitation remains unclear. The objective was to describe the relationship between time to CC, initiation of @entity1353 or positive pressure ventilation ( @entity2286 ) after stimulation/suction and 24-hour neonatal mortality/morbidity. DESIGN: Observational study. SETTING: A rural Tanzanian referral hospital. POPULATION: Depressed nonbreathing newborns. METHODS: Trained research assistants have observed every delivery (November 2009 through January 2014) using stop-watches and recorded data including fetal heart rate; time intervals from birth to CC and start of @entity1353 or @entity2286 and perinatal characteristics. MAIN OUTCOME MEASURES: Twenty-four-hour neonatal outcome (dead, admitted, normal). RESULTS: There were 19 863 liveborn @entity1 ; 16 770 (84.4%) initiated spontaneous respirations, 3093 (15.6%) received stimulation/suctioning to initiate @entity1353 . However, 1269 (41.0%) neonates failed to breath and received @entity2286 at 98    66 seconds and CC at 39    35 seconds after birth. Adverse outcomes in neonates receiving @entity2286 included 126 (9.9%) deaths and 100 (7.8%) neonatal admissions. In 1146/1269 (90%) neonates, CC occurred before @entity2286 and was associated with 209 (18%) deaths/admissions. In 98 (8%) neonates, CC followed initiation of @entity2286 with 14 (14%) deaths/admissions (P = 0.328). By logistic modelling, initiation of @entity2286 before versus after CC was not associated with @entity204 /admission when adjusted for time to @entity2286 . The risk for @entity204 /admission increased by 12% for every 30-second delay in @entity2286 (P = 0.001). CONCLUSIONS: This observational study failed to demonstrate any relationship between time to CC and onset of @entity1353 or initiation of @entity2286 following stimulation/suction, and 24-hour outcome. Delay in initiation of @entity2286 was significantly associated with @entity204 /admission. TWEETABLE ABSTRACT: No relationship between time to cord clamp, @entity1353 or ventilation and 24-hour deaths in depressed neonates.
