Delayed versus Immediate Cord Clamping in Preterm Infants Academic Article uri icon

abstract

  • BACKGROUND:The preferred timing of umbilical-cord clamping in preterm infants is unclear. METHODS:We randomly assigned fetuses from women who were expected to deliver before 30 weeks of gestation to either immediate clamping of the umbilical cord (≤10 seconds after delivery) or delayed clamping (≥60 seconds after delivery). The primary composite outcome was death or major morbidity (defined as severe brain injury on postnatal ultrasonography, severe retinopathy of prematurity, necrotizing enterocolitis, or late-onset sepsis) by 36 weeks of postmenstrual age. Analyses were performed on an intention-to-treat basis, accounting for multiple births. RESULTS:Of 1634 fetuses that underwent randomization, 1566 were born alive before 30 weeks of gestation; of these, 782 were assigned to immediate cord clamping and 784 to delayed cord clamping. The median time between delivery and cord clamping was 5 seconds and 60 seconds in the respective groups. Complete data on the primary outcome were available for 1497 infants (95.6%). There was no significant difference in the incidence of the primary outcome between infants assigned to delayed clamping (37.0%) and those assigned to immediate clamping (37.2%) (relative risk, 1.00; 95% confidence interval, 0.88 to 1.13; P=0.96). The mortality was 6.4% in the delayed-clamping group and 9.0% in the immediate-clamping group (P=0.03 in unadjusted analyses; P=0.39 after post hoc adjustment for multiple secondary outcomes). There were no significant differences between the two groups in the incidences of chronic lung disease or other major morbidities. CONCLUSIONS:Among preterm infants, delayed cord clamping did not result in a lower incidence of the combined outcome of death or major morbidity at 36 weeks of gestation than immediate cord clamping. (Funded by the Australian National Health and Medical Research Council [NHMRC] and the NHMRC Clinical Trials Centre; APTS Australian and New Zealand Clinical Trials Registry number, ACTRN12610000633088 .).

authors

  • Tarnow-Mordi, W
  • Morris, J
  • Kirby, A
  • Robledo, K
  • Askie, L
  • Brown, R
  • Evans, N
  • Finlayson, S
  • Fogarty, M
  • Gebski, V
  • Ghadge, A
  • Hague, W
  • Isaacs, D
  • Jeffery, M
  • Keech, A
  • Kluckow, M
  • Popat, H
  • Sebastian, L
  • Aagaard, K
  • Belfort, M
  • Pammi, M
  • Mohamed, Abdel Latif
  • Reynolds, G
  • Ariff, S
  • Sheikh, L
  • Chen, Y
  • Colditz, P
  • Liley, H
  • Pritchard, M
  • de Luca, D
  • de Waal, K
  • Forder, P
  • Duley, L
  • El-Naggar, W
  • Gill, A
  • Newnham, J
  • Simmer, K
  • Groom, K
  • Weston, P
  • Gullam, J
  • Patel, H
  • Koh, G
  • Lui, K
  • Marlow, N
  • Morris, S
  • Sehgal, A
  • Wallace, E
  • Soll, R
  • Young, L
  • Sweet, D
  • Walker, S
  • Watkins, A
  • Wright, I
  • Osborn, D
  • Simes, J

publication date

  • 2017