Supine versus Prone Position during Delayed Cord Clamping in Infants ≥36 Weeks: A Randomized Trial.

Area of Science:

• Neonatal care
• Perinatal research
• Obstetrics

Background:

• Delayed cord clamping (DCC) is recommended, but optimal newborn positioning during this practice remains unestablished.
• Current literature lacks guidance on infant positioning immediately after birth during DCC.

Purpose of the Study:

• To determine if prone positioning on the mother's chest during DCC increases newborn hematocrit levels at 30 hours of life compared to supine positioning.
• To compare cerebral tissue oxygenation (CrSO2) between prone and supine positions during DCC.

Main Methods:

• A randomized unblinded trial included healthy newborns (≥36 weeks gestational age) born vaginally with cephalic presentation.
• Infants were randomized to either prone or supine position, with umbilical cord clamping delayed to 1 minute after birth.
• Hematocrit at 30 hours of life was the primary outcome; cerebral tissue oxygenation was assessed using near-infrared spectroscopy as a secondary outcome.

Main Results:

• No statistically significant difference in hematocrit levels at 30 hours of life was observed between the supine (mean 52%) and prone (mean 53.1%) positions.
• Cerebral tissue oxygenation (CrSO2) levels at 30 hours were comparable between the supine (mean 84.1%) and prone (mean 82.2%) groups.
• No correlation was found between hematocrit and CrSO2 levels at 30 hours of life.

Conclusions:

• Prone and supine positioning immediately after birth during delayed cord clamping do not impact hematocrit levels at 30 hours of life.
• Further research is necessary to evaluate the effects of positioning on breastfeeding, maternal satisfaction, and long-term outcomes beyond 30 hours to establish definitive recommendations.