Randomised trial of cord clamping at very preterm birth: outcomes at 2 years

Abstract

ObjectiveTo report outcomes at 2 years corrected age for children of women recruited to a trial comparing alternative policies for timing of cord clamping and immediate neonatal care at very preterm birth.DesignParallel group randomised (1:1) trial.SettingEight UK tertiary maternity units.ParticipantsTwo hundred and seventy-six babies born to 261 women expected to have a live birth before 32+0 weeks’ gestation.InterventionsDeferred cord clamping (≥2 min) and immediate neonatal care with cord intact or immediate (≤20 s) clamping and immediate neonatal care after clamping.Main outcome measureComposite of death or adverse neurodevelopmental outcome at 2 years corrected age.ResultsSix babies born after 35+6 weeks were excluded. At 2 years corrected age, outcome data were not available for a further 52 children, leaving 218 for analysis (115 deferred clamping, 103 immediate clamping). Overall, 24/115 (21%) children allocated deferred clamping died or had an adverse neurodevelopmental outcome compared with 35/103 (34%) allocated immediate clamping; risk ratio (RR) 0.61 (95% CI 0.39 to 0.96); risk difference (RD) −13% (95% CI −25% to −1%). Multiple imputation for missing data gave an RR 0.69 (95% CI 0.44 to 1.09) and RD −9% (95% CI −21% to 2%).ConclusionsDeferred clamping and immediate neonatal care with cord intact may reduce the risk of death or adverse neurodevelopmental outcome at 2 years of age for children born very premature. Confirmation in larger studies is needed to determine the real benefits and harms.Trial registration number ISRCTN21456601.

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

“…One study published outcomes in early childhood for early clamping compared to delayed clamping (comparison 1) shortly after our search date and was therefore not included in the analysis. 39 Authors of this study found that delayed clamping may reduce the risk of death or adverse neurodevelopmental outcome at 2 years of age for children born ,32 weeks, but confirmation in larger studies is needed.…”

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

“…Les enfants nés à moins de 32 semaines et affectés aléatoirement au groupe de CRC à 120 secondes ou plus, en comparaison avec le groupe de CIC, présentaient un moindre risque de mortalité ou de devenir neurodéveloppemental défavorable à l'âge de 2 ans (critère composite; RR : 0,61; IC à 95 % : 0,39-0,96) 13 .…”

Guidelines on Deferred Cord Clamping and Cord Milking: A Systematic Review

“…b This statement is a compilation of 2 other WHO statements. 41,46 in infants born at 23 to 27 6 weeks' gestation who received UCM. In their systematic review, Balasubramanian et al 69 also found significantly increased risk of severe IVH (grades 3 or higher) among preterm infants ,34 weeks who received UCM compared with DCC in 4 RCTs.…”

“…3 RCTs revealed that DCC reduced the risks of intraventricular hemorrhage (IVH), necrotizing enterocolitis, and sepsis among preterm infants; reduced the need for blood transfusions and respiratory support; improved iron stores at 3 to 6 months; and improved neurodevelopmental outcomes at 2 years. [3][4][5][6] In a systematic review of 7 RCTs, UCM reduced the risks of IVH and oxygen requirement and improved hemoglobin levels among preterm infants. 7 However, a recent large RCT raised concerns about the risks of IVH with UCM.…”