Extrauterine Placental Transfusion In Neonatal Resuscitation Of Very Low Birth Weight Infants

This prospective randomized controlled study will be conducted among 2 groups, all of them are preterm infants with birth weight less than 1500 g ("very low birth weight" (VLBW)) who are delivered by caesarean section, in the first interventional group an extrauterine placental transfusion (EPT) will be done during neonatal resuscitation with respiratory pressure support. There will be a delayed cord clamping (DCC) of at least 30 - 60 seconds in the control group, before starting neonatal resuscitation with respiratory support.

In EPT approach preterm born infants are delivered by caesarean section with the placenta still attached to the infant via the umbilical cord. Then, placental transfusion is performed up to several minutes by holding the placenta ~40-50cm above the babies' heart level while respiratory support by mask continuous-positive-airway-pressure (CPAP) is initiated simultaneously.

Extrauterine placental transfusion may give more blood in babies delivered by cesarean section and may improve perfusion during the fetal-to-neonatal transition with impact on neonatal outcome.

Inclusion criteria

• Birth weight < 1500 gram ("very low birth weight infant")
• Delivery by caesarean section
• Gestational age > 23+6 weeks

Exclusion criteria

• Vaginal delivery
• Fetal or maternal risk (i.e. compromise, emergency c-section)
• Congenital anomalies and/or major cardiac defects
• Placental abruption or previa with hemorrhage
• Placenta accreta or increta
• Monochorionic multiples (i.e. Di/Mo or Mo/Mo twins)
• Parents declined study