Delayed cord clamping in infants born less than 35 weeks: A retrospective study

Abstract

Evidence supports delayed cord clamping (DCC) in preterm infants. However, practice variation exists, and many preterm infants do not receive DCC despite multiple benefits and lack of harm. We aim to 1) study the rate of DCC in preterm infants, 2) compare the difference between infants who received DCC and those who did not receive DCC and 3) investigate the reasons for not performing DCC. We conducted this retrospective study to evaluate DCC practice at our institution since its implementation in September 2015. We collected and analyzed the data on DCC of 30-45 sec duration in inborn infants < 35 weeks gestation admitted to the neonatal intensive care unit from June 2016- June 2019. The primary outcome was the rate of delayed cord clamping. Of the 447 infants, 275 (62%) received DCC. The rate of DCC was 36%, 54%, and 66% in infants < 27 weeks, 27-29 weeks and > 30 weeks gestation, respectively (p = 0.001). Infants not receiving DCC were smaller, of lower gestational age, and more likely to be delivered via cesarean section than those who received DCC (p < 0.0001). Infants not receiving DCC had a higher rate of receiving PPV or intubation and a 1minute Apgar score of < 5 compared to those receiving DCC. We could not establish the reason for not performing DCC because of inadequate documentation in the medical records. The rate of DCC is low in clinical practice, particularly among extremely preterm infants.