Discussion
VLBW, blood loss
BLOOD LOSS, DETACHMENT, EPP
To our knowledge, this is the first randomized clinical trial of EPP as an alternative approach for PBCC instead of DCC in infants with VLBW. Our study found that the EPP approach resulted in similar mean hematocrit levels 24 hours after birth and was safe given similar neonatal outcomes in EPP and DCC groups. While numerous studies have shown a significantly higher hematocrit level after DCC in babies born spontaneously, studies in infants born by cesarean delivery are controversial.An intriguing observation of our study was that infants receiving EPP had significantly higher SpIn this trial, the EPP approach was feasible in all singleton and most multiple births. This finding is consistent with published data in neonates born at termCompared with PBCC approaches using mobile beside resuscitation platforms, EPP has several advantages: first, the procedure does not delay the course of cesarean delivery compared with DCC, in which surgical procedures are stopped until the cord is clamped. Although we did not record time from delivery of the infant to placental detachment, data from Welsh et alAlthough there was a statistically significant difference in maternal blood loss during cesarean delivery, the higher blood loss in mothers in the EPP compared with DCC group is not considered clinically significant by obstetricians. In addition, significance was not confirmed in ANCOVA. The higher rate of blood loss in mothers in the EPP group may be explained by differences in the surgical procedure when performing EPP. Whereas in EPP oxytocin is administered after the placenta has been detached, in DCC it is usually administered immediately after umbilical cord clamping but before the placenta has been detached. Further studies on the EPP technique should address the issue of maternal blood loss in terms of safety.