Association of Deferred vs Immediate Cord Clamping With Severe Neurological Injury and Survival in Extremely Low-Gestational-Age Neonates

Lodha, Abhay; Shah, Prakesh S.; Soraisham, Amuchou; Rabi, Yacov; Mehrem, Ayman Abou; Singhal, Nalini

doi:10.1001/jamanetworkopen.2019.1286

Cited by 21 publications

(21 citation statements)

References 40 publications

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“…Meta-analyses of more recent studies have shown DCC, compared with early cord clamping (ECC), is associated with higher haemoglobin and haematocrit, higher blood pressure, fewer blood transfusions, reduced intraventricular haemorrhage, and decreased hospital mortality 3 4. A very large population-based study showed reduced severe neurological injury5 in infants 22–28 weeks’ gestational age (GA) receiving DCC.…”

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confidence: 99%

Haematocrit in <35 weeks preterm infants who received at least 60 seconds of delayed cord clamping: a retrospective observational study

Nudelman¹,

Goel

Jegatheesan

et al. 2019

bmjpo

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ObjectiveTo describe haematocrit at birth in preterm infants who received ≥60 s of delayed cord clamping (DCC).DesignRetrospective observational study.SettingA California public hospital with an American Academy of Pediatrics level 4 neonatal intensive care unit, with 3500–4000 deliveries annually.Participants467 preterm infants born at <35 weeks’ gestational age (GA) between January 2013 and December 2018.Primary and secondary outcome measuresHaematocrit reference ranges for 0–4 hours after birth and paired haematocrit differences between 0–4 and 4–24 hours.MethodsHaematocrits were obtained when clinically indicated and collected from arterial, venous and capillary sources. Haematocrits obtained after packed red blood cell transfusions were excluded. We summarised the first available haematocrit between 0 and 4 hours by GA strata. We used mixed-effects linear regression to describe the associations between haematocrit and predictor variables including GA, male sex and hours after an infant’s birth. We also compared paired haematocrits at 0–4 and 4–24 hours after birth.ResultsThe median GA of the 467 included infants was 33.3 weeks, birth weight was 1910 g and DCC duration was 60 s. The mean (95% CI) first haematocrit at 0–4 hours was 46.6 (45.0% to 48.1%), 51.2 (49.6% to 52.8%), 50.6 (49.1% to 52.1%), 54.3 (52.8% to 55.8%) and 55.6 (54.6% to 56.6%) for infants 23–29, 30–31, 32, 33 and 34 weeks’ GA strata, respectively. The subanalysis of 174 infants with paired haematocrits at 0–4 and 4–24 hours showed that for each additional hour after birth, the mean (95% CI) haematocrit increased by 0.2 (0.1% to 0.3%), 0.2 (0.1% to 0.4%) and 0.1 (0.0% to 0.2%) for infants in 23–29, 30–31 and 32 weeks’ GA strata, respectively. The subanalysis showed no change between the paired haematocrits in the 33 and 34 weeks’ GA strata.ConclusionsOur study describes haematocrit in preterm infants who received ≥60 s DCC as standard of care. Haematocrit during the first 0–4 hours in our study is higher than the previously described reference ranges prior to DCC becoming routine clinical practice. The paired second haematocrit at 4–24 hours is higher than haematocrit at 0–4 hours.

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confidence: 99%

Haematocrit in <35 weeks preterm infants who received at least 60 seconds of delayed cord clamping: a retrospective observational study

Nudelman¹,

Goel

Jegatheesan

et al. 2019

bmjpo

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“…Since survival with good neurodevelopmental outcomes is a goal for all neonates, a simple interventionlike DCC-that decreases the risk of death, severe intraventricular hemorrhage, and periventricular leukomalacia is desirable. However, while the study by Lodha et al6 demonstrated decreased severe…”

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confidence: 89%

“…Despite evidence from the study by Lodha et al 6 and evidence from the 18 RCTs 4 demonstrating improved survival in preterm infants with DCC, clinicians may continue to be more comfortable immediately taking over the resuscitation process in favor of waiting out a minute of uncertainty.…”

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confidence: 99%

“…These differences may be associated with rates of survival and the development of severe neurological injury. In addition, because the study by Lodha et al 6 those with late clamping." 5(p980) Despite this recommendation, data in the study by Lodha et al, 6 collected between 2011 and 2015, demonstrates that many participating centers did not practice DCC; half of the centers (13 of 26) had DCC rates of 30% or less.…”

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confidence: 99%

“…In addition, because the study by Lodha et al 6 those with late clamping." 5(p980) Despite this recommendation, data in the study by Lodha et al, 6 collected between 2011 and 2015, demonstrates that many participating centers did not practice DCC; half of the centers (13 of 26) had DCC rates of 30% or less. In addition, 1890 of 8221 potential patients (23.0%) were excluded from the study owing to the unavailability of information about cord clamping, demonstrating the persistent lack of proper documentation around this important quality improvement measure.…”

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confidence: 99%

See 2 more Smart Citations

Increased Odds of Survival or Prevention of Severe Neurological Injury in Extremely Low-Gestational-Age Neonates

McAdams

2019

JAMA Netw Open

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The primary goal of newborn resuscitation guidelines is to promote a healthy birth transition in neonates. As part of these guidelines, placental transfusion via delayed cord clamping (DCC) has been recommended in both preterm and term newborns by several governing organizations. 1-3 A 2018 systematic review of 18 randomized clinical trials (RCTs) 4 that compared DCC (cord clamping deferred for Ն30 seconds after birth) with early cord clamping (cord clamped in Յ30 seconds) in 2834 preterm infants, including 996 infants with 28 weeks or fewer of gestation, demonstrated that DCC was associated with reduced hospital mortality (number needed to benefit = 20) with high Grading of Recommendations, Assessment, Development, and Evaluation quality of evidence.

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Blood Management in the Premature Neonate

Jungerwirth

Hsieh

2021

Essentials of Blood Product Management in Anesthesia Practice

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Association of Deferred vs Immediate Cord Clamping With Severe Neurological Injury and Survival in Extremely Low-Gestational-Age Neonates

Abstract: This cohort study compares neonatal outcomes after deferred cord clamping vs immediate cord clamping in extremely low-gestational-age neonates.

Cited by 21 publications

References 40 publications

Haematocrit in <35 weeks preterm infants who received at least 60 seconds of delayed cord clamping: a retrospective observational study

Haematocrit in <35 weeks preterm infants who received at least 60 seconds of delayed cord clamping: a retrospective observational study

Increased Odds of Survival or Prevention of Severe Neurological Injury in Extremely Low-Gestational-Age Neonates

Blood Management in the Premature Neonate

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