73 Milking of the Cut-Cord during Stabilization of Very Preterm Infants: A Randomized Controlled Trial (The MoCC Study)
Notice bibliographique
Résumé
Abstract Background Delayed cord clamping (DCC) for at least 30-60 seconds after birth has been recommended as the standard of care for most preterm infants. However, DCC can be contraindicated or not optimal in certain situations (for example, in cases of interrupted placental circulation). Milking of the long-cut cord (MoCC) while providing stabilization and supporting breathing of the infant after birth is proposed as an alternative to DCC. Objectives To investigate the feasibility of MoCC during stabilization of very preterm infants after birth. Design/Methods This parallel-group, randomized controlled trial was conducted at IWK Health, which is a tertiary care perinatal centre in Halifax, Canada. Infants born to eligible, consenting women presenting in preterm labor at <32 weeks’ gestation were randomized to the MoCC group (where the infant received 30 seconds of DCC while initial resuscitation steps were taken by the obstetric provider, followed by milking of the long-cut cord one time over 10 seconds, with breathing supported by the neonatal team) or to the current standard of care group. For these infants, DCC for 30-60 seconds depended on whether the baby was breathing at birth or not. Primary outcome was feasibility in terms of percentage recruitment, intervention compliance, safety, and study completion. Short-term clinical outcomes were collected. Analysis was by intention-to-treat. Results Fifty infants were randomized to either MoCC (25) or DCC (25) (see Figure below). Baseline characteristics were similar. All infants completed the study. One infant in the MoCC group and five infants in the DCC group did not receive the allocated intervention. Median (IQR) time to cord milking was 62 seconds (54, 99) and median (IQR) length of the cut cord milked was 20 cm (14, 29). MoCC was not associated with adverse effects when compared with DCC (see Table). Conclusion Milking the long-cut cord one time after 30 seconds of DCC, while supporting breathing, was feasible and not associated with adverse effects. A large randomized controlled trial is required to assess the efficacy of this approach for clinical outcomes. MoCC may be especially useful when immediate clamping is indicated. Potential competing interests Dr. El-Naggar has served as a consultant for Aerogen Pharma Limited and is a site investigator of its funded study: A Partially-Blind, Randomized, Controlled, Parallel-Group, Dose-Ranging Study to Determine the Efficacy, Safety and Tolerability of AeroFactTM (SF-RI 1 surfactant for inhalation combined with a dedicated drug delivery system) in Preterm Infants at Risk for Worsening Respiratory Distress Syndrome.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,005 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,003 | 0,002 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,002 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,005 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».