17 Aug Delayed Umbilical Cord Clamping in Preterm Infants May Reduce Complications and Need For Transfusions
MedicalResearch: What is the background and main findings of the study?
Dr. Chiruvolu: There is growing evidence that delaying umbilical cord clamping (DCC) in very preterm infants may improve hemodynamic stability after birth and decrease the incidence of major neonatal morbidities such as intraventricular hemorrhage (IVH) and necrotizing enterocolitis. Recently, the American College of Obstetricians and Gynecologists (ACOG) published a committee opinion that supported delaying umbilical cord clamping in preterm infants, with the possibility for a nearly 50% reduction in IVH. However, the practice of DCC in preterm infants has not been widely adopted, mainly due to the concern of a delay in initiating resuscitation in this vulnerable population. Furthermore, there is uncertainty regarding the magnitude of published benefits in very preterm infants, since prior trials were limited by small sample sizes, wide variability in the technique and inconsistent reporting of factors that may have contributed to clinical outcomes.
We recently implemented a delaying umbilical cord clamping quality improvement (QI) process in very preterm infants at a large delivery hospital. The objective of this cohort study was to evaluate the clinical consequences of a protocol-driven delayed umbilical cord clamping implementation in singleton infants born £ 32 weeks gestation. We hypothesized that DCC would not compromise initial resuscitation and would be associated with significant decrease in early red blood cell transfusions and IVH compared to a historic cohort.
Delayed umbilical cord clamping was performed on all the 60 eligible infants. 88 infants were identified as historic controls. Gestational age, birth weight and other demographic variables were similar between both groups. There were no differences in Apgar scores or admission temperature, but significantly fewer infants in theDelayed umbilical cord clamping cohort were intubated in delivery room, had respiratory distress syndrome or received red blood cell transfusions in the first week of life compared to the historic cohort. A significant reduction was noted in the incidence of IVH inDelayed umbilical cord clamping cohort compared to historic control group (18.3% versus 35.2%). After adjusting for gestational age, an association was found between the incidence of IVH and Delayed umbilical cord clamping with IVH significantly lower in the DCC cohort compared to historic cohort with odds ratio of 0.36 (95% CI 0.15 to 0.84, P <0.05). There were no significant differences in mortality and other major morbidities.
MedicalResearch: What should clinicians take away from this report?
- Delayed umbilical cord clamping process can be successfully implemented in preterm infants.
- Delayed umbilical cord clamping, as performed in our institution was associated with a significant reduction in IVH and early red blood cell transfusions.
- Delayed umbilical cord clamping in very preterm infants appears to be safe, feasible and effective with no adverse consequences.
MedicalResearch: What are the recommendations for the future research as a result of this study?
Dr. Chiruvolu: Further clinical studies are needed to optimize timing and technique of delaying umbilical cord clamping and report the impact of this potentially valuable procedure on higher risk preterm infants and long-term neurodevelopmental outcomes of the very preterm infants.
Chiruvolu A, Tolia VN, Qin H, et al. Effect of Delayed Cord Clamping on Very Preterm Infants. Am J Obstet Gynecol 2015;213…
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Arpitha Chiruvolu MD FAAP (2015). Delayed Umbilical Cord Clamping in Preterm Infants May Reduce Complications and Need For Transfusions