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a University of Rhode Island, Kingston, Rhode Island
b Brown Medical School, Providence, Rhode Island
OBJECTIVE. This study compared the effects of immediate (ICC) and delayed (DCC) cord clamping on very low birth weight (VLBW) infants on 2 primary variables: bronchopulmonary dysplasia (BPD) and suspected necrotizing enterocolitis (SNEC). Other outcome variables were late-onset sepsis (LOS) and intraventricular hemorrhage (IVH).
STUDY DESIGN. This was a randomized, controlled unmasked trial in which women in labor with singleton fetuses <32 weeks’ gestation were randomly assigned to ICC (cord clamped at 5–10 seconds) or DCC (30–45 seconds) groups. Women were excluded for the following reasons: their obstetrician refused to participate, major congenital anomalies, multiple gestations, intent to withhold care, severe maternal illnesses, placenta abruption or previa, or rapid delivery after admission.
RESULTS. Seventy-two mother/infant pairs were randomized. Infants in the ICC and DCC groups weighed 1151 and 1175 g, and mean gestational ages were 28.2 and 28.3 weeks, respectively. Analyses revealed no difference in maternal and infant demographic, clinical, and safety variables. There were no differences in the incidence of our primary outcomes (BPD and suspected NEC). However, significant differences were found between the ICC and DCC groups in the rates of IVH and LOS. Two of the 23 male infants in the DCC group had IVH versus 8 of the 19 in the ICC group. No cases of sepsis occurred in the 23 boys in the DCC group, whereas 6 of the 19 boys in the ICC group had confirmed sepsis. There was a trend toward higher initial hematocrit in the infants in the DCC group.
CONCLUSIONS. Delayed cord clamping seems to protect VLBW infants from IVH and LOS, especially for male infants.
Key Words: delayed cord clamping • intraventricular hemorrhage • IVH • late-onset sepsis • VLBW infants • randomized • controlled trial
Abbreviations: BPD—bronchopulmonary dysplasia • CUS—cranial ultrasound • DCC—delayed cord clamping • ICC—immediate cord clamping • IVH—intraventricular hemorrhage • LOS—late-onset sepsis • NEC—necrotizing enterocolitis • ROP—retinopathy of prematurity • SNEC—suspected necrotizing enterocolitis • VLBW—very low birth weight • CI—confidence interval
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C A Ultee, J van der Deure, J Swart, C Lasham, and A L van Baar Delayed cord clamping in preterm infants delivered at 34 36 weeks' gestation: a randomised controlled trial Arch. Dis. Child. Fetal Neonatal Ed., January 1, 2008; 93(1): F20 - F23. [Abstract] [Full Text] [PDF]
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D. J R Hutchon Commercial cord blood banking: immediate cord clamping is not safe. BMJ, October 28, 2006; 333(7574): 919 - 919. [Full Text]
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J. M. C. Cernadas, G. Carroli, and J. Lardizabal Effect of Timing of Cord Clamping on Neonatal Venous Hematocrit Values and Clinical Outcome at Term: A Randomized, Controlled Trial: In Reply Pediatrics, September 1, 2006; 118(3): 1318 - 1319. [Full Text] [PDF]
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P. F. van Rheenen and B. J. Brabin Effect of Timing of Cord Clamping on Neonatal Venous Hematocrit Values and Clinical Outcome at Term: A Randomized, Controlled Trial Pediatrics, September 1, 2006; 118(3): 1317 - 1318. [Full Text] [PDF]
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A. G.S. Philip Delayed Cord Clamping in Preterm Infants Pediatrics, April 1, 2006; 117(4): 1434 - 1435. [Full Text] [PDF]
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