Abstract
Delayed cord clamping (DCC) may be beneficial in very-preterm and very-low-birth-weight infants. This study was a randomized unmasked controlled trial. It was performed at three centers of the NICHD (National Institute of Child Health and Human Development) Neonatal Research Network. DCC in very-preterm and very-low-birth-weight infants will result in an increase in hematocrit levels at 4 h of age. Infants with a gestational age of 24 to 28 weeks were randomized to either early cord clamping (<10 s) or DCC (30 to 45 s). The primary outcome was venous hematocrit at 4 h of age. Secondary outcomes included delivery room management, selected neonatal morbidities and the need for blood transfusion during the infants' hospital stay. A total of 33 infants were randomized: 17 to the immediate cord clamping group (cord clamped at 7.9±5.2 s, mean±s.d.) and 16 to the DCC (cord clamped at 35.2±10.1 s) group. Hematocrit was higher in the DCC group (45±8% vs 40±5%, P<0.05). The frequency of events during delivery room resuscitation was almost identical between the two groups. There was no difference in the hourly mean arterial blood pressure during the first 12 h of life; there was a trend in the difference in the incidence of selected neonatal morbidities, hematocrit at 2, 4 and 6 weeks, as well as the need for transfusion, but none of the differences was statistically significant. A higher hematocrit is achieved by DCC in very-low-birth-weight infants, suggesting effective placental transfusion.
Highlights
Autologous transfusion of blood to the newborn as a result of delayed cord clamping (DCC) at birth is a well-described phenomenon in term infants resulting in higher hematocrit and blood volume,[1,2,3,4,5] as well as physiological changes in gastrointestinal, cardiopulmonary[6,7,8] and renal functions.[9]
It is noted that participants in these studies were larger and of higher gestational age because the survival rate of very-low-birth-weight infants in that period was low
The neonatal morbidities recorded were intraventricular hemorrhage by cranial ultrasound as classified by Papile et al.,[18] culture-proven late-onset sepsis, necrotizing enterocolitis greater than stage 2 as per Bell’s classification,[19] bronchopulmonary dysplasia defined as oxygen treatment at 36 weeks post-menstrual age and retinopathy of prematurity
Summary
Autologous transfusion of blood to the newborn as a result of delayed cord clamping (DCC) at birth is a well-described phenomenon in term infants resulting in higher hematocrit and blood volume,[1,2,3,4,5] as well as physiological changes in gastrointestinal, cardiopulmonary[6,7,8] and renal functions.[9]In preterm low-birth-weight infants, placental transfusion results in lower incidence of respiratory distress syndrome,[10] higher blood volumes and hematocrit, as well as fewer infants with hypotension.[11]. More recent studies involving very-preterm and very-low-birth-weight infants documented a higher hematocrit and red cell volume,[12,13,14] lower incidence of intraventricular hemorrhage and late-onset sepsis.[15] In two systematic reviews, Rabe et al.[16,17] concluded that DCC in very-low-birth-weight infants may be beneficial and seems to be safe. Despite these positive observations, immediate cord clamping (ICC) is still the standard practice among obstetricians
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