Effects of delayed cord clamping in very-low-birth-weight infants.

Department of Pediatrics, Women and Infants' Hospital, 101 Dudley Street, Providence, RI 02905, USA.
Journal of perinatology: official journal of the California Perinatal Association (Impact Factor: 2.35). 04/2011; 31 Suppl 1:S68-71. DOI: 10.1038/jp.2010.186
Source: PubMed

ABSTRACT Delayed cord clamping (DCC) may be beneficial in very-preterm and very-low-birth-weight infants.
This study was a randomized unmasked controlled trial. It was performed at three centers of the NICHD (National Institute of Child Health and Human Development) Neonatal Research Network. DCC in very-preterm and very-low-birth-weight infants will result in an increase in hematocrit levels at 4 h of age. Infants with a gestational age of 24 to 28 weeks were randomized to either early cord clamping (<10 s) or DCC (30 to 45 s). The primary outcome was venous hematocrit at 4 h of age. Secondary outcomes included delivery room management, selected neonatal morbidities and the need for blood transfusion during the infants' hospital stay.
A total of 33 infants were randomized: 17 to the immediate cord clamping group (cord clamped at 7.9±5.2 s, mean±s.d.) and 16 to the DCC (cord clamped at 35.2±10.1 s) group. Hematocrit was higher in the DCC group (45±8% vs 40±5%, P<0.05). The frequency of events during delivery room resuscitation was almost identical between the two groups. There was no difference in the hourly mean arterial blood pressure during the first 12 h of life; there was a trend in the difference in the incidence of selected neonatal morbidities, hematocrit at 2, 4 and 6 weeks, as well as the need for transfusion, but none of the differences was statistically significant.
A higher hematocrit is achieved by DCC in very-low-birth-weight infants, suggesting effective placental transfusion.

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    ABSTRACT: To investigate the effects of interventions promoting placental transfusion at delivery (delayed cord clamping or umbilical cord milking) compared with early cord clamping on outcomes among premature neonates of less than 32 weeks of gestation.
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    ABSTRACT: Autologous blood transfusion from the placenta to the neonate at birth has been proven beneficial. Transfusion can be accomplished by either delayed cord clamping or cord stripping. Both are equally effective in previous randomized trials. We hypothesized that combining these two techniques would further improve outcomes in preterm neonates. This was a prospective randomized trial for singleton deliveries with estimated gestational ages between 22 and 31 6/7 weeks. The control protocol required a 30-second delayed cord clamping while the test protocol instructed a concurrent cord stripping during the delay. The primary outcome was initial fetal hematocrit. We also examined secondary outcomes of neonatal mortality, length of time on the ventilator, days to discharge, peak bilirubin, number of phototherapy days and neonatal complication rates. Of the 67 patients analyzed, 32 were randomized to the control arm and 35 were randomized to the test arm. The gestational ages and fetal weights were similar between the arms. Mean hematocrit of the control arm was 47.75%, and mean hematocrit for the test arm was 47.71% (p-value 0.98). These results were stratified by gestational age, revealing the infants <28 weeks had an average hematocrit of 41.2% in the control arm and 44.7% in the test arm (p-value 0.12). In the infants with gestational ages ≥28 weeks, the control arm had an average hematocrit of 52.9%, which was higher than the test arm, which averaged 49.5% (p-value 0.04). The control arm received an average of 1.53 blood transfusions, while the test arm received 0.97 (p-value 0.33). The control arm had 3 neonatal deaths, and the test arm had none (p-value 0.10). The average number of days until discharge was 71.2 for the control arm and 67.8 for the test arm (p-value 0.66). The average number of days on the ventilator was 4.86 for the control arm and 3.06 for the test arm (p-value 0.34). Adding cord stripping to the delayed cord clamp does not result in an increased hematocrit. Data suggests trends in lower mortality and higher hematocrit in neonates born <28 weeks, but these were not statistically significant. Copyright © 2014 Elsevier Inc. All rights reserved.
    American Journal of Obstetrics and Gynecology 12/2014; DOI:10.1016/j.ajog.2014.12.017 · 3.97 Impact Factor


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