Delayed versus Immediate Cord Clamping in Preterm Infants

W. Tarnow-Mordi, J. Morris, A. Kirby, K. Robledo, L. Askie, R. Brown, N. Evans, S. Finlayson, M. Fogarty, V. Gebski, A. Ghadge, W. Hague, D. Isaacs, M. Jeffery, A. Keech, M. Kluckow, H. Popat, L. Sebastian, K. Aagaard, M. BelfortM. Pammi, M. Abdel-Latif, G. Reynolds, S. Ariff, L. Sheikh, Y. Chen, P. Colditz, H. Liley, M. Pritchard, D. de Luca, K. de Waal, P. Forder, L. Duley, W. El-Naggar, A. Gill, J. Newnham, K. Simmer, K. Groom, P. Weston, J. Gullam, H. Patel, G. Koh, K. Lui, N. Marlow, S. Morris, A. Sehgal, E. Wallace, R. Soll, L. Young, D. Sweet, S. Walker, A. Watkins, I. Wright, D. Osborn, J. Simes, Australian Placental Transfusion

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Abstract

BACKGROUND

The preferred timing of umbilical-cord clamping in preterm infants is unclear.

METHODS

We randomly assigned fetuses from women who were expected to deliver before 30 weeks of gestation to either immediate clamping of the umbilical cord (

RESULTS

Of 1634 fetuses that underwent randomization, 1566 were born alive before 30 weeks of gestation; of these, 782 were assigned to immediate cord clamping and 784 to delayed cord clamping. The median time between delivery and cord clamping was 5 seconds and 60 seconds in the respective groups. Complete data on the primary outcome were available for 1497 infants (95.6%). There was no significant difference in the incidence of the primary outcome between infants assigned to delayed clamping (37.0%) and those assigned to immediate clamping (37.2%) (relative risk, 1.00; 95% confidence interval, 0.88 to 1.13; P = 0.96). The mortality was 6.4% in the delayed-clamping group and 9.0% in the immediate-clamping group (P = 0.03 in unadjusted analyses; P = 0.39 after post hoc adjustment for multiple secondary outcomes). There were no significant differences between the two groups in the incidences of chronic lung disease or other major morbidities.

CONCLUSIONS

Among preterm infants, delayed cord clamping did not result in a lower incidence of the combined outcome of death or major morbidity at 36 weeks of gestation than immediate cord clamping. (Funded by the Australian National Health and Medical Research Council [NHMRC] and the NHMRC Clinical Trials Centre; APTS Australian and New Zealand Clinical Trials Registry number, ACTRN12610000633088.)

Original languageEnglish
Pages (from-to)2445-2455
Number of pages11
JournalThe New England Journal of Medicine
Volume377
Issue number25
DOIs
Publication statusPublished - 21 Dec 2017

Cite this

Tarnow-Mordi, W., Morris, J., Kirby, A., Robledo, K., Askie, L., Brown, R., ... Australian Placental Transfusion (2017). Delayed versus Immediate Cord Clamping in Preterm Infants. The New England Journal of Medicine, 377(25), 2445-2455. https://doi.org/10.1056/NEJMoa1711281