What is the Optimal time of Cord Clamping in Preterm Newborns?
BACKGROUND AND PURPOSE:
ACOG guidelines now call for waiting at least 30 to 60 seconds after birth before clamping the cord in preterm infants (see ‘Related ObG Topics’ below) if resuscitation unnecessary
Guidelines based on multiple studies showing benefit such as prevention of necrotizing enterocolitis and infection
Other guideline committees concur, however this practice is still not universal
Data limited with respect to mortality or incidence of neurodevelopmental disability
Mordi et al. (NEJM, 2017) determined the optimal timing for umbilical-cord clamping following delivery in preterm infants
Randomized controlled trial (RCT)
Australian Placental Transfusion Study (APTS)
Women expecting to delivery before 30 weeks gestation were randomized into
Immediate clamping of umblicial cord (≤10 seconds after delivery)
Delayed clamping (≥60 seconds after delivery)
The primary outcome was composite of 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
1566 liveborn < 30 weeks of gestation
782 were assigned to immediate cord clamping (median time 5 seconds)
784 were assigned to delayed cord clamping (median time 60 seconds)
There was no significant difference in composite of death or major morbidity between groups (37% delayed vs 37.2% immediate; P=0.96)
Mortality rate alone
Mortality was initially lower in the delayed group (6.4% vs 9.0%)
Adjusting for confounders, there was no significant difference
There were no significant differences between the two groups in the incidences of chronic lung disease or other major morbidities
Delayed cord clamping did not result in lower incidence of combined outcome of death or major morbidity in preterm infants at 36 weeks of gestation, compared to immediate clamping
The findings in this study differ from previous studies that did show less morbidity in the delayed clamping groups
Authors suggest that infants in the current study may have been less ill
A properly powered trial to assess mortality would require > 11,000 patients
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