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Delayed cord clamping safe, effective for very preterm infants
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Delayed cord clamping significantly reduced intraventricular hemorrhage and early red blood cell transfusions in very preterm infants.
The procedure also appeared safe, results showed.
Physicians frequently use delayed cord blood clamping on full-term infants. The practice is not common for preterm infants, despite an American College of Obstetricians and Gynecologists opinion issued in 2012 that recommended a 30- to 60-second delay in cord clamping for all newborns.
“When we were reviewing literature on delayed cord clamping, we found that it might be associated with good outcomes in preterm infants,” Arpitha Chiruvolu, MD, FAAP, a neonatal and perinatal medicine specialist at Baylor University Medical Center, said in a press release. “Still, delayed cord clamping is not widely practiced due to the concern of delaying resuscitation in this vulnerable population.”
Chiruvolu and colleagues designed their study to determine whether implementation of delayed cord clamping could reduce the incidence of intraventricular hemorrhage in very preterm infants without contributing to other adverse consequences.
The study included data from 60 infants delivered at 32 weeks or earlier (mean gestational age, 27.9 ± 2.8 weeks) between August 2013 and August 2014. The researchers left eligible infants attached to the placenta for 45 seconds following birth.
The investigators also analyzed data from a historical cohort of 88 infants born between August 2012 and August 2013 for comparison purposes. Those infants received immediate cord clamping at birth.
Infants in both cohorts were similar with regard to gestational age, birth weight and other demographic variables. The researchers observed no differences in Apgar scores or admission temperature between the cohorts.
Preterm infants who received delayed cord clamping experienced a significant reduction in the incidence of intraventricular hemorrhage compared with the historical cohort (18.3% vs. 35.2%).
Further, significantly fewer infants who received delayed cord clamping underwent intubation in the delivery room (18.3% vs. 62.2%; P < .0001), had respiratory distress syndrome (43.3% vs. 65.9%) or required red blood cell transfusion in the first week of life (13.3% vs. 33%).
After adjusting for gestational age, the researchers observed an association between delayed cord clamping and the risk for intraventricular hemorrhage. A significantly lower incidence of intraventricular hemorrhage occurred among infants who received delayed cord clamping compared with the historical cohort (OR = 0.36; 95% CI, 0.15-0.84).
No significant differences in deaths or other major morbidities occurred. Four infants who received delayed cord clamping died, compared with 10 infants from the historical cohort.
The researchers acknowledged the study’s observational design and single-institution design as potential limitations of their findings.
“We were impressed by the overall results, especially the significant reduction in intraventricular hemorrhage by almost 50%,” Chiruvolu said. “There were no adverse effects. There should be no hesitation in performing delayed cord clamping in very preterm infants.” – by Cameron Kelsall
Disclosure: The researchers report no relevant financial disclosures.
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