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Delayed, immediate cord clamping show similar outcomes at 36 weeks gestation

Delayed cord clamping did not lower the incidence of death or major morbidity at 36 weeks gestation compared with immediate cord clamping among preterm infants, according to data published in The New England Journal of Medicine.

“Various professional guidelines recommend delays of more than 30 seconds, 30 to 60 seconds, at least 60 seconds or 30 to 180 seconds, all if resuscitation is unnecessary. Nevertheless, delayed clamping is not universally performed, owing to continuing anxiety about the risks of delayed resuscitation or hyperbilirubinemia,” William Tarnow-Mordi, MB, ChB, from the National Health and Medical Research Council Clinical Trials Center at the University of Sydney, and colleagues wrote. “Whether delayed clamping alone has benefits with respect to mortality or the incidence of neurodevelopmental disability remains unknown.”

Researchers randomly assigned 1,634 fetuses from women who were expected to deliver before 30 weeks of gestation to either immediate clamping of the umbilical cord (10 seconds or less after delivery) or delayed clamping (60 seconds or more after delivery) to compare differences in death or major morbidity by 36 weeks of postmenstrual age. They performed analyses on an intention-to-treat basis and accounted for multiple births.

Of 1,566 fetuses born alive before 30 weeks of gestation, 782 were assigned to immediate cord clamping and 784 to delayed cord clamping. Analyses showed that there was no significant difference in the incidence of death or major morbidity between infants assigned to delayed clamping and those assigned to immediate clamping (37% vs. 37.2%; P = .96). Mortality was 6.4% in the delayed-clamping group and 9% in the immediate-clamping group (P = .39, in post hoc adjustment). In addition, incidence of chronic lung disease or other major morbidities was not significantly different between the two groups.

“We found no significant difference in the primary composite outcome of death or major morbidity at 36 completed weeks of postmenstrual age between infants assigned to delayed cord clamping and those assigned to immediate cord clamping,” Tarnow-Mordi and colleagues wrote. “There was also no significant difference in the primary outcome according to sex, gestational age, or method of delivery or in the originally defined primary composite outcome of death or major morbidity, which included chronic lung disease.” – by Savannah Demko

Reference:

American Pregnancy Association. Delayed Cord Clamping: What Are the Risks and Benefits? http://americanpregnancy.org/labor-and-birth/delayed-cord-clamping-risks-benefits/. Accessed on Nov. 8, 2017.

Disclosures: Tarnow-Mordi reports no relevant financial disclosures. Please see the study for a list of all other authors’ relevant financial disclosures.