Effects of Delayed Cord Clamping on Neonatal Outcomes in Pregestational Diabetes at Term [13O

Abstract

INTRODUCTION: Placental blood transfusion via delayed cord clamping can increase infant blood volume 10–20%. Hyperbilirubinemia is a well-known sequelae of infants born to diabetic mothers. Our study sought to evaluate the effects of delayed cord clamping on neonatal hyperbilirubinemia in a population prone to this phenomenon. METHODS: In January 2016, our institution implemented a thirty-second delayed cord clamping policy for provider-deemed eligible patients. This retrospective cohort study represents infants of pre-gestational diabetics who delivered before and after implementation. 72 patients were selected for each arm to achieve 80% power to detect a 15% difference between groups. Term singleton gestations were included. Study period was October 2014 to August 2017. Primary outcome was neonatal transcutaneous bilirubin. Secondary outcomes included serum bilirubin, jaundice requiring phototherapy, hypoglycemia, polycythemia, neonatal respiratory distress, and NICU admission. Subgroup analysis for outcomes in Type I diabetes and Type II diabetes was also performed. RESULTS: 145 patients were included in the final analysis. Transcutaneous bilirubin was 10.1 ± 3.4 for immediate cord clamping and 9.5 ± 3.4 for delayed cord clamping (P=.25). There were no statistically significant differences between groups in jaundice requiring phototherapy, hypoglycemia, polycythemia, neonatal respiratory distress, or NICU admission. No differences were observed in neonatal outcome by subgroup analysis of Type I versus Type II pre-gestational diabetes. CONCLUSION: In our study, there was no statistically significant increase in transcutaneous bilirubin in term infants of mothers with pre-gestational diabetes after undergoing 30 seconds of delayed cord clamping. Further research is needed to ascertain long-term neonatal effects.