240 Delayed Cord Clamping in Very Low Birthweight Infants Reduces the Incidence of Intraventricular Hemorrhage and Late Onset Sepsis

Abstract

Background: The current prevailing obstetrical practice at birth in the USA is that the umbilical cord of the very low birth weight (VLBW) infant is immediately clamped. The aim of this study was to compare the effects of immediate (ICC) and delayed (DCC) cord clamping on infants born between 24 and 31.6 weeks on two primary outcome variables: bronchopulmonary dysplasia (BPD) and suspected necrotizing enterocolitis (NEC). Secondary outcome variables were blood pressure, hematocrit, late onset sepsis (LOS), and intraventricular hemorrhage (IVH). The hypothesis was that DCC would result in less BPD and suspected NEC.Methods: This was an unmasked randomized controlled trial in which women in labor with infants between 24 and 31 weeks were randomized to ICC (cord clamped at 5 to 10 seconds) or DCC (30 to 45 seconds) groups. DCC infants were held 20–30 cm. below the introitus as possible. The exact time of cord clamping was measured. All neonatal care was at the discretion of the attending physicians.Results: Intention-to-treat analyses revealed no differences in maternal variables, birth weights, gestational age, Apgar scores, initial temperature, and peak serum bilirubin levels. There were no signficant differences in the incidence of BPD (25% vs 22%, p = .78) or suspected NEC (55% vs. 39%, p = .16). Significant differences in IVH (13 vs. 5, p = .03, OR 2.6, 955 CI, 1,6.5) and LOS (8 vs. 1, p = .01) were found between the ICC and DCC groups. In the ICC group, 12 had a grade I-2 IVH compared to 5 in the DCC group. One ICC infant had a grade 4 IVH.Conclusions: Delayed cord clamping appears to protect very low birth weight infants from IVH and sepsis. DCC is an easy to implement intervention.