MedicalResearch.com Interview with:
Abhay K Lodha MD, DM, MSc
Department of Pediatrics
Alberta Health Services
MedicalResearch.com: What is the background for this study?
Response: There is no physiological rationale for clamping the umbilical cord immediately after birth. In moderate (32+0 weeks-33+6 weeks) and late preterm infants (34+0 to 36+6), delayed cord clamping reduces the need for blood transfusions, leads to circulatory stability and improves blood pressure.
However, the information on the association of delayed cord clamping with outcomes for extremely low gestational age neonates (22-28 weeks of gestation) is limited.
MedicalResearch.com: What are the main findings?
Response: In this cohort study of 4680 extremely low gestational age neonates (ELGAN: 22-28 weeks of gestation), 1852 received delayed cord clamping and 2828 received immediate cord clamping.
Our study found that ELGAN who received delayed cord clamping or immediate cord clamping, delayed cord clamping was associated with reduced risk for the composite outcome of severe neurological injury (intraventricular hemorrhage grade ³ 3 with or without persistent periventricular echogenicity) or mortality than neonates who received immediate cord clamping.
MedicalResearch.com: What should readers take away from your report?
Response: We identified that in extremely low gestational age neonates (22-28 weeks of gestation preterm neonates), delayed cord clamping was associated with a reduction in the composite outcome of severe neurological injury or mortality. There was also reduced odds of mortality and severe neurological injury individually in some models. The impact of delayed cord clamping on late onset of sepsis and fluid administration may be favorable.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Further research in the form of randomised controlled trials required to answer questions related to optimal timing, optimal positioning to allow placental transfusion, interim measures (e.g., provision of resuscitation while waiting for cord clamping), and the impact of placental transfusion on parental wishes/volume for cord blood banking.
MedicalResearch.com: Is there anything else you would like to add?
Response: Our study is one of the largest population based, pragmatic cohorts in preterm infants born at or before 28 weeks of gestation. We used a uniform variable definitions across various centres limited potential errors and variability. The results of our study are based on a national cohort and are therefore generalizable. Our study has some limitations due to selection bias possible due to retrospective nature of the study. The delayed cord clamping should be attempted based on the clinical condition and discretion of medical team at the time of birth.
Lodha A, Shah PS, Soraisham AS, et al. Association of Deferred vs Immediate Cord Clamping With Severe Neurological Injury and Survival in Extremely Low-Gestational-Age Neonates. JAMA Netw Open.2019;2(3):e191286. doi:10.1001/jamanetworkopen.2019.1286
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