Deferred Cord Clamping: 15+ quick Q and As with Dr. Arpi!!!

Hi, welcome to Tala Talks NICU. Today, I'm here with Dr. RP Shirvalu, who is an expert in many things. She's an excellent neonatologist. She's done oodles of research. She's a very good friend of mine. She's an excellent mummy. And today, we are going to cover DCC very, very briefly in like one sentence answers. So this is going to be quick fire questions to Dr. RP. Number one, what is DCC? Deferred cord clamping. Why do we call it deferred not delayed? Delay comes to us as like, you know, probably delaying care or something like that. Deferred is more, it is under our control. We are doing it wantedly. So we should all start using deferred now? Yes. I'm going to have to get used to that. Okay. How is the baby held during DCC? Preferably at or below the level of the placenta. Is there any time that you can do skin to skin? With the baby while you're doing DCC? In a term baby or in a vigorous premature baby who is breathing, active, and in a vaginal delivery, you can definitely put the baby above the level of the placenta skin to skin on the abdomen. How long should we do DCC in a preemie baby? At least 60 seconds. Term baby? At least three minutes. At least three minutes? Is there any time that we should be doing cord milking in our babies? A non-vigorous term baby could get cord milking. What about a preterm baby? Can you do a cord milking in a preterm baby? If you cannot do deferred cord clamping in a baby who is greater than 28 weeks, you can do cord milking. Just not 28 weeks? Not below 28 weeks. No cord milking in babies below 28 weeks? Yes. Why is it so important that babies breathe before the clamp? Breathing helps in natural cardiopulmonary transition and breathing dilates the pulmonary vessels so that they can act as a sink for this blood which is rich in immunoglobulins and stem cells. So it is very important that the babies breathe. So basically the pressure in the lungs falls because the vasodilation so it's more like a negative pressure? Yes. And so more blood wants to leave the placenta and kind of drain into the lungs? Yes. Okay so that's what breathing helps do? Yes. So we have to wait for babies to breathe. How long does it take for a preemie baby to breathe? On an average the premature babies breathe 20 to 30 seconds. And how many what percentage of babies are breathing by 60 seconds preemie babies? 90% of them are breathing. So how do we get our OB colleagues to just wait even if a baby is non-vigorous? We need to be cheering them and say it's okay it's okay and then you know and encourage them to wait for 60 seconds. How do we make sure the babies don't get cold during DCC? Maintain the room temperature 74 degrees. Should babies be stimulated during DCC? If they are not breathing they can be mildly stimulated by gentle rub on the back. Are there any negative effects for mummies that have had that have DCC done? We have not seen any adverse effects with the mothers with regards to the postpartum hemorrhage or infection. What about if we want to collect some of the blood for cord banking or if we want to get genetic studies or a blood culture or something on the blood? Absolutely that can be done concurrently with with deferred cord clamping. What are the benefits of DCC in a preemie baby? Decreased intraventricular hemorrhage, a decreased need for the red blood cell transfusions and decreased mortality. I mean massive ones very difficult to argue against it. Yes. What about in term babies? In term babies increased hematocrit, decreased anemia, improved iron stores, increased myelination of the brain, improved neurodevelopmental outcome with regards to the motor and motor and sensory. Wow. At four years. Wow I mean how impressive is that? Yes. Like in something that's free. Yes. Basically so easy compared to everything else that we do in neonatology which by the way they've been doing this for like hundreds of thousands of years. Yes. Until neos and obese came in and we were like nope let's get the baby out of here as quickly as possible. Are there any babies that should not get DCC? If the placenta is detaching and you know mom has severe hemodynamic instability, there is cord avulsion, there is like true knot of the umbilical cord. Those are the situations. So basically the only times that we don't do it is when we're worried that there really isn't blood having a pathway to get to the baby. Absolutely. Whether the placenta isn't attached anymore, whether the uterus isn't attached anymore, whether there's a tight knot in the cord, whether the cord is literally ripped. Obviously in those cases keeping the baby attached is not going to help anything. Yes yes and also a monochorionic complex pregnancies, high drops, twin to twin transfusion syndrome. Those are the ones where you have like complex vascular connections and everything. Probably deferred cord clamping is not going to help. How much blood is normally transferred in DCC? A good amount of blood, 20 to 30 ml per kilo of blood is transferred. Literally one to two regular transfusions that in the NICU basically. Okay. Thank you so much. That was amazing. Thank you. Thank you.