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

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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, William
  • Morris, Jonathan
  • Kirby, Adrienne
  • Robledo, Kristy
  • Askie, Lisa
  • Brown, Rebecca
  • Evans, Nicholas
  • Finlayson, Sarah
  • Fogarty, Michael
  • Gebski, Val
  • Ghadge, Alpana
  • Hague, Wendy
  • Isaacs, David
  • Jeffery, Michelle
  • Keech, Anthony
  • Kluckow, Martin
  • Popat, Himanshu
  • Sebastian, Lucille
  • Aagaard, Kjersti
  • Belfort, Michael
  • Pammi, Mohan
  • Abdel-Latif, Mohamed
  • Reynolds, Graham
  • Ariff, Shabina
  • Sheikh, Lumaan
  • Chen, Yan
  • Colditz, Paul
  • Liley, Helen
  • Pritchard, Margo
  • de Luca, Daniele
  • de Waal, Koert
  • Forder, Peta
  • Duley, Lelia
  • El-Naggar, Walid
  • Gill, Andrew
  • Newnham, John
  • Simmer, Karen
  • Groom, Katie
  • Weston, Philip
  • Gullam, Joanna
  • Patel, Harshad
  • Koh, Guan
  • Lui, Kei
  • Marlow, Neil
  • Morris, Scott
  • Sehgal, Arvind
  • Wallace, Euan
  • Soll, Roger
  • Young, Leslie
  • Sweet, David
  • Walker, Susan
  • Watkins, Andrew
  • Wright, Ian
  • Osborn, David
  • Simes, John

publication date

  • December 21, 2017