ObjectivesFor very preterm births, to compare alternative policies for umbilical cord clamping and immediate neonatal care.DesignParallel group randomised (1:1) trial, using sealed opaque numbered envelopes.SettingEight UK tertiary maternity units.Participants261 women expected to have a live birth before 32 weeks, and their 276 babies.InterventionsCord clamping after at least 2 min and immediate neonatal care with cord intact, or clamping within 20 s and immediate neonatal care after clamping.Main outcome measuresIntraventricular haemorrhage (IVH), death before discharge.Results132 women (137 babies) were allocated clamping ≥2 min and neonatal care cord intact, and 129 (139) clamping ≤20 s and neonatal care after clamping; six mother-infant dyads were excluded (2, 4) as birth was after 35+6 weeks, one withdrew (death data only available) (0, 1). Median gestation was 28.9 weeks for those allocated clamping ≥2 min, and 29.2 for those allocated clamping ≤20 s. Median time to clamping was 120 and 11 s, respectively. 7 of 135 infants (5.2%) allocated clamping ≥2 min died and 15 of 135 (11.1%) allocated clamping ≤20 s; risk difference (RD) −5.9% (95% CI −12.4% to 0.6%). Of live births, 43 of 134 (32%) had IVH vs 47 of 132 (36%), respectively; RD −3.5% (−14.9% to 7.8%). There were no clear differences in other outcomes for infants or mothers.ConclusionsThis is promising evidence that clamping after at least 2 min and immediate neonatal care with cord intact at very preterm birth may improve outcome; a large trial is urgently needed.Trial registrationISRCTN 21456601.

BackgroundGastro-oesophageal reflux is prevalent in preterm infants. Despite widespread use in clinical practice, there is still much controversy over the efficacy and safety of drug interventions, particularly antacid therapy.ObjectiveTo systematically review the effects of antacid therapy on preterm infants with symptoms of gastro-oesophageal reflux, and to assess the safety of these interventions.MethodsWe carried out an electronic search of the Cochrane central register of controlled trials (CENTRAL, The Cochrane Library), MEDLINE (1966–present), EMBASE (1980–present) and CINAHL (1982–present) as well as other online sources. Participants were preterm infants (<37 weeks gestation) with gastro-oesophageal reflux disease who were receiving care on a neonatal unit. We assessed the effects of histamine-2 receptor antagonists, proton pump inhibitors and alginates against placebo, primarily to see if they reduced the symptoms of reflux.ResultsSix studies were included in this review. Meta-analysis could not be carried out due to a lack of studies assessing the same intervention with the same outcomes. Omeprazole therapy significantly reduced the oesophageal acid exposure percentage time with pH<4 (p<0.01) and sodium alginate significantly decreased gastro-oesophageal reflux episodes (p=0.024). Metoclopramide and ranitidine showed a significant increase in gastro-oesophageal reflux disease symptoms versus placebo (p<0.04). No significant results were found for the use of esomeprazole or lansoprazole versus placebo.ConclusionsThere is insufficient evidence available to conclude whether antacid therapy is effective or safe when treating gastro-oesophageal reflux disease in preterm infants. Further research is needed into this topic and caution should be taken when administering antacids to preterm infants.Trial registration numberCRD42017078778

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Background Our neonatal service is recruiting to the Cord Trial, which is comparing immediate with deferred umbilical cord clamping for very preterm births. For deferred clamping, initial neonatal care is at the mother’s bedside using a standard resuscitaire. This study is assessing acceptability of bedside care to clinicians. Methods Clinicians providing bedside stabilisation are asked to complete an anonymous questionnaire. Results Questionnaires were distributed for 9 births and 7 were returned for 6 births: 4 vaginal and 2 caesarean. The gestational age ranged from 25–31 weeks. Deferred cord clamping was performed in 5 births, for one the cord was clamped early due to a short cord and stabilisation provided at the room side. Five infants required respiratory support, 3 intubation and 2 mask ventilation. The neonatal team were asked how bedside care compared to usual room side care. The preliminary results are summarised below. Abstract PC.113 Table Much worse Worse The same Better Much better Access to the baby 0 4 0 0 2 Assessment 1 0 4 0 1 Access to equipment 2 0 4 0 0 Providing interventions 0 1 5 0 0 Communication with parents 0 0 1 2 3 Overall how would you rate bedside care for the parents 0 0 1 3 2 Overall how would you rate bedside care for yourself 0 1 2 1 2 Conclusions Bedside care using current equipment appears to be feasible for infants undergoing deferred umbilical cord clamping and offers potential improvements in parental experience. Further research into bedside care is warranted.

Background and aims:The normal Reflux Index (percentage time with pH < 4) in preterm infants has a wide range (0.7 -11.9%) reflecting the limited data for preterm infant. A recent UK National patient safety alert led to a change in practise requiring that the position of a nasogastric tube has to be confirmed by checking the acidity of gastric aspirates prior to a feed.