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Master Thesis

Impact néonatal du clampage retardé du cordon ombilical sur l’ictère chez le nouveau-né à terme

Abstract : Introduction: the umbilical cord clamping delay is a controversial issue. Most maternity hospitals currently practice early clamping, but randomized trials and meta-analyses have objectified the value of delaying cord clamping in term or premature newborns over the past decade. Objectives: the main objective is to evaluate the relationship between the delayed umbilical cord clamping and the occurrence of jaundice requiring phototherapy in a population of term newborns at low risk of neonatal jaundice. The secondary objectives are to compare the maximum value of transcutaneous bilirubin, the value of the peak of bilirubinemia and the risk of polyglobulia depending on whether the umbilical cord is clamped early or late. Method: quantitative observational study of the "ice-elsewhere" type with retrospective data collection between June and October 2017, in two maternity hospitals, one performing delayed cord clamping almost systematically, the other having chosen not to perform it in term newborns. We collected data on jaundice monitoring and polycythemia from delayed-clamped infants in Maternity A and then Maternity B by matching the exact birth term, sex of the newborn and feeding pattern. In total we collected data on 360 newborns. Results: the two populations were comparable on parity, birth weight, as well as on the Apgar score at 1, 5 and 10 minutes. There was no significant difference between bour two groups regarding the need for phototherapy (2 vs 5, p = 0.449), the value of the peak of transcutaneous bilirubin (p = 0.780) and the day of the peak (p = 0.690). No differences were found for bilirubinemia peak (p = 0.890), red blood cell count (p = 0.624), hemoglobin (p = 0.394). There were no cases of polycythemia in our population. Conclusion: our study showed that there was no difference in the use of phototherapy in term and low-risk newborns between the delayed and early clamping groups. The clamp mode does not change the value of the transcutaneous bilirubin peak or the bilirubinemia peak. The practice of delayed clamping in a population of term newborns at low risk of jaundice does not appear to be associated with an increase in the number of jaundice, which should not lead to an increase in the length of time newborns remain in the maternity ward.
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Eva Egreteau. Impact néonatal du clampage retardé du cordon ombilical sur l’ictère chez le nouveau-né à terme. Gynécologie et obstétrique. 2019. ⟨dumas-02283961⟩

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