Timing of Umbilical Cord Clamping Among Infants Born at 22 Through 27 Weeks' Gestation

CH Backes; H Huang; JD Iams; JA Bauer; PJ Giannone

Disclosures

J Perinatol. 2016;36(1):35-40. 

In This Article

Abstract and Introduction

Abstract

Objective: To investigate the safety, feasibility and efficacy of delayed cord clamping (DCC) compared with immediate cord clamping (ICC) at delivery among infants born at 22 to 27 weeks' gestation.

Study Design: This was a pilot, randomized, controlled trial in which women in labor with singleton pregnancies at 22 to 27 weeks' gestation were randomly assigned to ICC (cord clamped at 5 to 10 s) or DCC (30 to 45 s).

Results: Forty mother–infant pairs were randomized. Infants in the ICC and DCC groups had mean gestational ages (GA) of 24.6 and 24.4 weeks, respectively. No differences were observed between the groups across all available safety measures, although infants in the DCC group had higher admission temperatures than infants in the ICC group (97.4 vs 96.2 °F, P=0.04). During the first 24 h of life, blood pressures were lower in the ICC group than in the DCC group (P<0.05), despite a threefold greater incidence of treatment for hypotension (45% vs 12%, P<0.01). Infants in the ICC group had increased numbers of red blood transfusions (in first 28 days of life) than infants in DCC group (4.1±3.9 vs 2.8±2.2, P=0.04).

Conclusion: Among infants born at an average GA of 24 weeks', DCC appears safe, logistically feasible, and offers hematological and circulatory advantages compared with ICC. A more comprehensive appraisal of this practice is needed.

Introduction

In most medical settings, clamping and cutting of the umbilical cord occurs within seconds following delivery.[1] Suggested advantages of this immediate separation include active management of the third stage of labor, prompt resuscitation of the neonate and less volume overload.[2,3] However, over the past decade, several important benefits of delayed umbilical cord clamping (DCC) have been observed for preterm infants.[4–6] A recent Cochrane review (15 trials, 738 preterm infants) showed that DCC, compared with immediate cord clamping (ICC), resulted in higher hematocrits, less exposure to blood products, lower incidence of necrotizing enterocolitis and an almost 50% lower risk of intraventricular hemorrhage (IVH).[7] However, the majority of evidence supporting DCC in preterm infants comes from infants >28 weeks' gestation and concerns that DCC will delay resuscitation and may worsen outcomes have precluded enrollment of infants born at lower gestational ages (GAs).[8]

Recently, the American College of Obstetricians and Gynecologists (ACOG), the American Academy of Pediatrics (AAP), and the World Health Organization (WHO) all issued statements supporting the practice of DCC at birth in preterm infants, but called for the need for a better understanding of the safety and feasibility of the practice among preterm infants born <28 weeks' gestation.[9–11] Without evidence-based recommendations to guide clinical care, many obstetricians perform ICC for infants delivered <28 weeks' gestation.[1] This study was designed to evaluate the safety and feasibility of DCC among infants born at 22 through 27 weeks' gestation.

The secondary objective was to evaluate the potential efficacy of DCC in comparison with ICC in this subgroup of preterm infants.

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