Effect of Delayed Cord Clamping Above Versus Below the Perineum on Preterm Neonatal Hematocrit [13OP

Abstract

INTRODUCTION: The objective is to determine the difference in neonatal hematocrit when delayed cord clamping is performed above versus below the perineum. METHODS: Patients with anticipated preterm delivery between 30–36 6/7 weeks were randomized to 60 second delayed cord clamping either above or below the perineum after vaginal delivery. Primary outcome was difference in twenty-four hour neonatal hematocrit between groups. Secondary outcomes included Neonatal Intensive Care Unit (NICU) admissions, neonate's need for phototherapy or blood transfusion, one minute APGAR<4 and five minute APGAR<7. RESULTS: Of 103 patients consented to the study, 29 were ineligible prior to randomization and 13 did not complete to study. Sixty one patients completed the study (31 above and 30 below to perineum). There were no significant differences in maternal demographic characteristics or comorbidities. Mean gestational age was 35.5 (above) and 34.6 (below), P=.119. No statistical difference was found in neonatal hematocrit at 24-hours of life between the two groups; 51.5 above versus 52.6 below (P=.572). Correspondingly, none of the secondary outcomes were statistically different. CONCLUSION: When comparing delayed cord clamping above versus below the perineum in preterm deliveries greater than or equal to 30 weeks gestation, there is no difference in the neonatal hematocrit at 24 hrs of life or secondary neonatal outcomes. Delayed cord clamping can safely be performed above the perineum concomitant with skin to skin contact for vigorous preterm infants.