Delayed Cord Clamping Uptake and Outcomes for Infants Born Very Preterm in California.

Abstract

To investigate whether the purported benefits of DCC translate into a reduction in mortality and intraventricular hemorrhage (IVH) among preterm neonates in practice. This was a prospective cohort study of very preterm infants constructed from data from the California Perinatal Quality Collaborative for infants admitted into 130 California neonatal intensive care units (NICUs) within the first 28 days of life from 2016 through 2020. Individual-level analyses were conducted using log-binomial regression models controlling for confounders and allowing for correlation within hospitals to examine the relationship of DCC to the outcomes of mortality and IVH. Hospital-level analyses were conducted using Poisson regression models with robust variance controlling for confounders Results: Among 13,094 included very preterm infants (5,856 with DCC and 7,220 without), DCC was associated with a 44% lower risk of mortality (adjusted RR: 0.56, 95% CI: 0.47 - 0.66). Furthermore, every 10% increase in the hospital rate of DCC among preterm infants was associated with a 5% lower hospital mortality rate among preterm infants (aRR: 0.95, 95% CI: 0.92 - 0.98). DCC was associated with severe IVH at the individual-level, but not at the hospital-level. At the individual-level and hospital-level, the use of DCC was associated with lower mortality among preterm infants admitted to NICUs in California. These findings are consistent with clinical trial results, suggesting that the effects of DCC seen in clinical trials are translating to improved survival in practice.