Duration of Cord Clamping and Neonatal Outcomes in Very Preterm Infants

Abstract

BackgroundDelayed cord clamping (DCC, ≥30s) increases blood volume in newborns and is associated with fewer blood transfusions and short-term neonatal complications. The optimal timing of cord clamping for very preterm infants should maximize placental transfusion without interfering with stabilization and resuscitation.AimWe compared the effect of different durations of DCC, 30-45s vs. 60-75s, on delivery room (DR) and neonatal outcomes in preterm infants <32 weeks gestational age (GA).MethodsThis is a single-center prospective observational study. Data were collected prospectively from eligible infants from two groups: 30-45s DCC group (January 2008 to February 2011, n = 187) and 60-75s DCC group (March 2011 to April 2014, n = 166).ResultsThe 60-75s DCC group compared to the 30-45s DCC group had higher hematocrits at <2 hours (49.2% vs. 47.4%, p = 0.02). In infants <28 weeks GA, the 12–36 hours hematocrit was higher in the 60-75s DCC group compared to the 30-45s DCC group (47.9% vs. 42.1%, p = 0.002). The 60-75s DCC group had reductions in DR intubation (11% vs. 22%, p = 0.004), hypothermia on admission (1% vs. 5%, p = 0.01), surfactant therapy (13% vs. 28%, p = 0.001), intubation in the first 24 hours (20% vs. 34%, p = 0.004), any intubation (27% vs. 40%, p = 0.007), and any red blood cell transfusion (20% vs. 33%, p = 0.008) during the hospitalization compared to the 30-45s DCC group. These reductions remained significant after adjusting for GA, gender and >48 hours of antenatal steroid exposure. There was no difference between the two groups in neonatal death, intraventricular hemorrhage, chronic lung disease, late onset sepsis, necrotizing enterocolitis and severe retinopathy of prematurity.ConclusionIn this study cohort increasing DCC duration from 30-45s to 60-75s is associated with decreased hypothermia on admission, neonatal respiratory interventions and red blood cell transfusions without increase in neonatal mortality and morbidities.

Delayed Cord Clamping and Umbilical Cord Milking among Infants in California Neonatal Intensive Care Units

“…There is not a consensus on the optimal timing of delay, but one quality improvement study in very preterm infants found that increasing the duration from 30 to 45seconds to 60 to 75 seconds is associated with decreased hypothermia on admission, neonatal respiratory interventions, and red blood cell transfusions without increase in neonatal mortality and morbidities. 18 Our study was consistent with prior research indicating that cesarean delivery may be associated with decreased likelihood of receiving DCC. 19 A survey of practitioners in the United Kingdom found that the most commonly expressed concern detracting from DCC was maternal bleeding at cesarean section, especially with less experienced obstetricians.…”

Body temperature at nursery admission in a cohort of healthy newborn infants: results from an observational cross-sectional study

“…We also evaluated the impact of DCC on hypothermia. Its benefits have been shown by several randomized trials, and include increased placental transfusion, cardiovascular stability, cerebral oxygenation and lower risk for both severe intraventricular haemorrhage and late-onset sepsis [17]. The higher duration of DCC (60-75 s) has also been associated with a lower incidence of hypothermia at birth in preterm infants [17].…”

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

“…We speculate that our findings could be owing to improved cardiovascular stability and reduced fluctuations in cerebral blood flow, a lower number of fluid boluses, increased superior vena cava blood flow, and stable blood pressure after DCC. 22 , 23 , 24 , 25 , 26 , 27 …”