Uncertainty Persists About Benefits of Delayed Cord Clamping In Extremely Premature Infants

MedicalResearch.com Interview with:

David Osborn MB BS MM PhD FRACP Clinical Associate Professor, University of Sydney Senior Neonatologist, Royal Prince Alfred Hospital

Dr. David Osborn

David Osborn MB BS MM PhD FRACP
Clinical Associate Professor, University of Sydney
Senior Neonatologist, Royal Prince Alfred Hospital

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: In an analysis of trials of placental transfusion at delivery by either delayed umbilical cord clamping or cord milking in infants born before 30 weeks gestation, placental transfusion was associated with short term benefits including increased hemoglobin, fewer blood transfusions, improved blood pressure and reduced late onset sepsis, with no significant effect on other outcomes. There were insufficient data regarding effects of placental transfusion on survival and long term disability.

The Australian Placental Transfusion Study (APTS) is a randomised controlled trial that aims to determine if delayed cord clamping (≥ 60 seconds) compared to early cord clamping (≤10 seconds) in 1600 infants born before 30 weeks gestation results in improved newborn outcomes and disability free survival.

In this echocardiographic sub study, the aim was to determine the effect of placental transfusion on systemic blood flow in the first day after birth in 266 infants randomly allocated to delayed versus early cord clamping (133 infants in each group). The primary outcome was superior vena cava (SVC) flow (cardiac input) which overcomes the problem of shunts across the adapting heart which affect the usefulness of measuring ventricular outputs in the first days after birth.

In infants born <30 weeks gestation, delayed cord clamping had no effect on the principle measure of systemic blood flow (SVC flow) during the first 24 hours compared to immediate cord clamping. However, right ventricular output (RVO) was lower in the delayed cord clamping group. This was not predicted and may be a chance finding. Further analysis suggests the effect of cord clamping on RVO could be mediated by its effect on hemoglobin. This may be a positive or negative adaptive change. There was no evidence of an increase in right to left ductal shunting suggestive of high pulmonary blood pressure to explain the difference in RVO. Delayed cord clamping resulted in a 8.9g/L greater increase in hemoglobin to 6 hours but had no effect on ductus arteriosus size, shunt direction or treatment, no effect on blood pressure or its treatment, and no effect on blood gas parameters and other cardiovascular variables in the first 24 hours.

MedicalResearch.com: What should readers take away from your report?
Response:

This is the largest study of the cardiorespiratory effects of delayed cord clamping in preterm infants born <30 weeks. There was no evidence that delayed cord clamping was associated with an improvement in cardiovascular adaptation in these infants.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: Uncertainty persists about the potential benefits and harms of delayed cord clamping in extremely premature infants. The clinical outcomes of the large APTS trial and similar trials are needed to inform practice.

MedicalResearch.com: Is there anything else you would like to add?

Response: The APTS trial will complete enrollment in December 2016 with clinical outcomes to discharge anticipated before the end of 2017.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

The Journal of Pediatrics
Available online 26 August 2016
Effect of Delayed Cord Clamping on Systemic Blood Flow: A Randomized Controlled Trial
Himanshu Popat, FRACP, Kristy P. Robledo, MBiostat, Lucille Sebastian, PhD, Nicholas Evans,DM, Andrew Gill, FRACP,Martin Kluckow, PhD, Sanjay Sinhal, FRACP, Koert de Waal, PhD,William Tarnow-Mordi, PhD, David Osborn, PhD ,

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