A Randomized Controlled Trial of Immediate versus Delayed Umbilical Cord Clamping in Multiple-Birth Infants Born Preterm

Abstract

Background: Delayed cord clamping (DCC) improves placental transfusion and increases blood volume in preterm infants when compared with immediate cord clamping (ICC). However, evidence to support DCC in multiple-birth preterm infants is still lacking. Objective: To compare the outcomes of ICC versus DCC in preterm infants of multiple births. Study Design: Women with a multiple pregnancy, including twins and triplets with a gestational age of 28–36 weeks, were randomized to receive ICC (23 women and 50 infants) or DCC for 30–60 s (24 and 51 infants). The infants’ hematocrit on admission, superior vena cava (SVC) flow measured within 24 h, and hematocrit at 8 weeks of age were compared. The use of uterotonic agents during delivery was not controlled in this study. Result: All infants were delivered by cesarean section (CS) except for 2 sets of twins, 1 in each group. Maternal and infant baseline characteristics in both groups were comparable. There were no significant differences between the groups in admission hematocrit, SVC flow measured within 24 h, hematocrit at 8 weeks of age, or any other neonatal outcomes. The incidence of maternal postpartum hemorrhage (PPH) was higher in the DCC group (4.3% in ICC vs. 25% in DCC, p = 0.04). Conclusion: DCC for 30–60 s did not improve placental transfusion or increase systemic blood flow in multiple-birth infants born preterm, mostly by CS, when compared with ICC. The finding of a higher PPH rate in the DCC group raises concerns about the maternal safety of this procedure in this patient population.

Umbilical Cord Management for Newborns <34 Weeks' Gestation: A Meta-analysis

“…With our review, we add new information, because we identified and included 11 additional recently published trials. [25][26][27][28][29][30][31][32][33][34][35] Although previous reviews included preterm infants born at less than 37 weeks' gestational age, 4,8 our review is limited to infants born at less than 34 weeks'. Although late preterm infants have increased risk for admission to neonatal intensive care and poor developmental outcome compared with term infants, they do not have the same serious morbidities experienced by less mature preterm infants.…”

What does the evidence tell us? Revisiting optimal cord management at the time of birth

“…It makes sense to provide them with more of their own blood through placental transfusion at birth [51,52]. Studies of multiple births have demonstrated feasibility of providing OCM to twins and triplets [53,54]. Thus, multiple births should not be routinely excluded.…”

Directive clinique no 424 : Prise en charge du cordon ombilical chez le nourrisson prématuré ou à terme

“…Il existe peu de données sur la prise en charge du cordon chez les jumeaux prématurés, car elles se limitent à un seul ECR de faible envergure 17 (80 jumeaux, dont 55 issus de grossesses monochoriales) et à deux études de cohortes 18,19 . Une méta-analyse révèle qu'aucun des quatre essais incluant des jumeaux n'avait stratifié les résultats d'après ce paramètre 5 .…”