Would of love to see an example on the discussion with the OB team on what the DCC plan is on a premature infant. Most of the Neo's I work with seem impatient to wait for the minute while the OB is stimulating past 30 seconds on apneic kid.
That discussion happens long before the delivery. Present the evidence. Get buy in from both sides. I view it as handing over the initial steps to the OB team, so I coach them through the whole minute reminding them of when to stimulate, when to back off the suctioning, gentle handling, etc. They have expressed great appreciation that I am watching over their shoulder for that minute. But if the baby remains apneic and poor tone after about 30 seconds, I let them know to clamp at that time. The biggest gains from DCC are probably when the baby breathes before the clamping, but not all babies allow that. Thanks for all your great comments.
thanks for this nice video and talk on 99nicu. are they any proven benefits of intact cord resuscitation versus delayed cord clamping alone? does it only permits an increased rate of delayed cord clamping? is it beneficial in case of HIE?
These are questions we do not have answers to yet. There are ongoing trials to assess intact cord resuscitation. The group at Concord Neonatal company are pretty convinced it is better based on mostly animal physiology studies. HIE has not been studied as far as I know, but resuscitation can not wait for that group. So the only option would be intact cord resuscitation or immediate cord clamping.
You can. But the net amount of transfusion to the baby does not seem to more after 3 minutes. Remember blood is flowing into baby by the umbilical veins but leaving baby by the umbilical arteries. In fact, the doppler study showed that 25% of the time, the venous flow stopped first while the arterial flow continued - meaning blood would be leaving baby and not coming back.
@@natetexsun Thank you. Have you ever waited longer? Most Midwives I know "wait for white". Often they don't bother to cut the cord until after the placenta is out. Can be up to 30 min. And they have excellent results.
@@amyhaas4301 As the neonatologist waiting anxiously to help resuscitate the baby, I can't see waiting that long. My hope is there are many deliveries that I am not called to getting delayed cord clamping for a generous amount of time.
Every reference I refer to is on the video screen. I put them by first author's last name, the journal and the year of publication. They should be searchable with that information.
Excellent multimedia summary of cord clamping backed by evidence
Thank you.
It's really good and a palatable presentation..thank you sir..waiting to have more presentation on neonatology
Would of love to see an example on the discussion with the OB team on what the DCC plan is on a premature infant. Most of the Neo's I work with seem impatient to wait for the minute while the OB is stimulating past 30 seconds on apneic kid.
That discussion happens long before the delivery. Present the evidence. Get buy in from both sides. I view it as handing over the initial steps to the OB team, so I coach them through the whole minute reminding them of when to stimulate, when to back off the suctioning, gentle handling, etc. They have expressed great appreciation that I am watching over their shoulder for that minute. But if the baby remains apneic and poor tone after about 30 seconds, I let them know to clamp at that time. The biggest gains from DCC are probably when the baby breathes before the clamping, but not all babies allow that. Thanks for all your great comments.
very clear and comprehensive! I'm convinced
Thank you, really helpful and straight forward
You are welcome
thanks for this nice video and talk on 99nicu.
are they any proven benefits of intact cord resuscitation versus delayed cord clamping alone?
does it only permits an increased rate of delayed cord clamping?
is it beneficial in case of HIE?
These are questions we do not have answers to yet. There are ongoing trials to assess intact cord resuscitation. The group at Concord Neonatal company are pretty convinced it is better based on mostly animal physiology studies. HIE has not been studied as far as I know, but resuscitation can not wait for that group. So the only option would be intact cord resuscitation or immediate cord clamping.
If arterial and veinal flow continue for 4.5 min., why not wait that long before clamping?
You can. But the net amount of transfusion to the baby does not seem to more after 3 minutes. Remember blood is flowing into baby by the umbilical veins but leaving baby by the umbilical arteries. In fact, the doppler study showed that 25% of the time, the venous flow stopped first while the arterial flow continued - meaning blood would be leaving baby and not coming back.
@@natetexsun Thank you. Have you ever waited longer? Most Midwives I know "wait for white". Often they don't bother to cut the cord until after the placenta is out. Can be up to 30 min. And they have excellent results.
@@amyhaas4301 As the neonatologist waiting anxiously to help resuscitate the baby, I can't see waiting that long. My hope is there are many deliveries that I am not called to getting delayed cord clamping for a generous amount of time.
Can you please share references?
Every reference I refer to is on the video screen. I put them by first author's last name, the journal and the year of publication. They should be searchable with that information.