Delayed Versus Immediate Cord Clamping in Preterm Infants EDITORIAL COMMENT

Australian Placental Transfusion

Research output: Contribution to journalEditorial

Abstract

Systemic reviews have shown that delaying the time of umbilical cord clamping can improve outcomes of preterm newborns. One such study found enhanced placental transfusion through delayed cord clamping, cord-palpation, or a combination of the 2 practices caused a lower infection and mortality rate when compared with immediate clamping. Despite this recent body of evidence, concerns exist about harm from delayed resuscitation and hyperbilirubinemia causing current professional guidelines to vary significantly.

This unblinded, randomized controlled trial compared the rates of a composite outcome of death and major morbidity between delayed and immediate cord clamping in infants born before 30 weeks of gestation. This study took place in 25 participating centers across 25 countries between 2010 and 2017. Eligible participants were randomly assigned to receive either immediate cord clamping defined as clamping within 10 seconds after delivery or delayed clamping defined as clamping at 60 or more seconds without cord palpation. The primary study outcomes were death, severe brain injury, severe retinopathy of prematurity, necrotizing enterocolitis, and late-onset sepsis, each diagnosed by 36 weeks of postmenstrual age. Tests for interaction were used to detect heterogeneity in the data between the primary outcomes across 3 subgroups: gestational age (= 27 week), sex, and method of delivery.

A total of 1566 infants were deemed eligible for the study with 782 assigned to immediate cord clamping and 784 assigned to delayed cord clamping. The average times of clamping for the delayed and immediate cohorts were 60 seconds and 5 seconds, respectively. Adherence to the randomized protocol varied between the groups (94.9% for the immediate cohort, 73.2% in the delayed cohort) with the primary reason for nonadherence in the delayed cohort being clinical concern about infant well-being. No significant difference was found in the primary outcome at 36 weeks between immediate clamping (37.2%) and delayed clamping (37.0%) (relative risk [RR], 1.00; 95% confidence interval [CI], 0.88-1.13; P = 0.96). Death by 36 weeks postmenstrual age occurred in 9.0% of those in the immediate cohort and 6.4% in the delayed clamping group (RR, 0.69; 95% CI, 0.49-0.97; P = 0.03 unadjusted and 0.39 after post hoc adjustment for multiple secondary comparisons). More infants in the immediate clamping cohort received red blood cell tranfusions (60.5% vs 52.1% in the delayed clamping cohort). There were no significant differences in Apgar score, peak bilirubin level, or other major morbidities.

The results of this study show that there is no significant difference on the rates of mortality or major morbidity at 36 weeks of gestation among preterm infants receiving immediate umbilical cord clamping versus delayed clamping.

Original languageEnglish
Pages (from-to)265-266
Number of pages2
JournalOBSTETRICAL & GYNECOLOGICAL SURVEY
Volume73
Issue number5
DOIs
Publication statusPublished - May 2018

Cite this

Australian Placental Transfusion. / Delayed Versus Immediate Cord Clamping in Preterm Infants EDITORIAL COMMENT. In: OBSTETRICAL & GYNECOLOGICAL SURVEY. 2018 ; Vol. 73, No. 5. pp. 265-266.
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title = "Delayed Versus Immediate Cord Clamping in Preterm Infants EDITORIAL COMMENT",
abstract = "Systemic reviews have shown that delaying the time of umbilical cord clamping can improve outcomes of preterm newborns. One such study found enhanced placental transfusion through delayed cord clamping, cord-palpation, or a combination of the 2 practices caused a lower infection and mortality rate when compared with immediate clamping. Despite this recent body of evidence, concerns exist about harm from delayed resuscitation and hyperbilirubinemia causing current professional guidelines to vary significantly.This unblinded, randomized controlled trial compared the rates of a composite outcome of death and major morbidity between delayed and immediate cord clamping in infants born before 30 weeks of gestation. This study took place in 25 participating centers across 25 countries between 2010 and 2017. Eligible participants were randomly assigned to receive either immediate cord clamping defined as clamping within 10 seconds after delivery or delayed clamping defined as clamping at 60 or more seconds without cord palpation. The primary study outcomes were death, severe brain injury, severe retinopathy of prematurity, necrotizing enterocolitis, and late-onset sepsis, each diagnosed by 36 weeks of postmenstrual age. Tests for interaction were used to detect heterogeneity in the data between the primary outcomes across 3 subgroups: gestational age (= 27 week), sex, and method of delivery.A total of 1566 infants were deemed eligible for the study with 782 assigned to immediate cord clamping and 784 assigned to delayed cord clamping. The average times of clamping for the delayed and immediate cohorts were 60 seconds and 5 seconds, respectively. Adherence to the randomized protocol varied between the groups (94.9{\%} for the immediate cohort, 73.2{\%} in the delayed cohort) with the primary reason for nonadherence in the delayed cohort being clinical concern about infant well-being. No significant difference was found in the primary outcome at 36 weeks between immediate clamping (37.2{\%}) and delayed clamping (37.0{\%}) (relative risk [RR], 1.00; 95{\%} confidence interval [CI], 0.88-1.13; P = 0.96). Death by 36 weeks postmenstrual age occurred in 9.0{\%} of those in the immediate cohort and 6.4{\%} in the delayed clamping group (RR, 0.69; 95{\%} CI, 0.49-0.97; P = 0.03 unadjusted and 0.39 after post hoc adjustment for multiple secondary comparisons). More infants in the immediate clamping cohort received red blood cell tranfusions (60.5{\%} vs 52.1{\%} in the delayed clamping cohort). There were no significant differences in Apgar score, peak bilirubin level, or other major morbidities.The results of this study show that there is no significant difference on the rates of mortality or major morbidity at 36 weeks of gestation among preterm infants receiving immediate umbilical cord clamping versus delayed clamping.",
author = "{Australian Placental Transfusion} and William Tarnow-Mordi and Jonathan Morris and Adrienne Kirby and Kristy Robledo and Lisa Askie and Rebecca Brown and Nicholas Evans and Sarah Finlayson and Michael Fogarty and Val Gebski and Alpana Ghadge and Wendy Hague and David Isaacs and Michelle Jeffery and Anthony Keech and Martin Kluckow and Himanshu Popat and Lucille Sebastian and Kjersti Aagaard and Michael Belfort and Mohan Pammi and Mohamed Abdel-Latif and Graham Reynolds and Shabina Ariff and Lumaan Sheikh and Yan Chen and Paul Colditz and Helen Liley and Margo Pritchard and {de Luca}, Daniele and {de Waal}, Koert and Peta Forder and Lelia Duley and Walid El-Naggar and Andrew Gill and John Newnham and Karen Simmer and Katie Groom and Philip Weston and Joanna Gullam and Harshad Patel and Guan Koh and Kei Lui and Neil Marlow and Scott Morris and Arvind Sehgal and Euan Wallace and Roger Soll and Leslie Young and David Sweet and Susan Walker and Andrew Watkins and Ian Wright and David Osborn and John Simes",
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Delayed Versus Immediate Cord Clamping in Preterm Infants EDITORIAL COMMENT. / Australian Placental Transfusion.

In: OBSTETRICAL & GYNECOLOGICAL SURVEY, Vol. 73, No. 5, 05.2018, p. 265-266.

Research output: Contribution to journalEditorial

TY - JOUR

T1 - Delayed Versus Immediate Cord Clamping in Preterm Infants EDITORIAL COMMENT

AU - Australian Placental Transfusion

AU - Tarnow-Mordi, William

AU - Morris, Jonathan

AU - Kirby, Adrienne

AU - Robledo, Kristy

AU - Askie, Lisa

AU - Brown, Rebecca

AU - Evans, Nicholas

AU - Finlayson, Sarah

AU - Fogarty, Michael

AU - Gebski, Val

AU - Ghadge, Alpana

AU - Hague, Wendy

AU - Isaacs, David

AU - Jeffery, Michelle

AU - Keech, Anthony

AU - Kluckow, Martin

AU - Popat, Himanshu

AU - Sebastian, Lucille

AU - Aagaard, Kjersti

AU - Belfort, Michael

AU - Pammi, Mohan

AU - Abdel-Latif, Mohamed

AU - Reynolds, Graham

AU - Ariff, Shabina

AU - Sheikh, Lumaan

AU - Chen, Yan

AU - Colditz, Paul

AU - Liley, Helen

AU - Pritchard, Margo

AU - de Luca, Daniele

AU - de Waal, Koert

AU - Forder, Peta

AU - Duley, Lelia

AU - El-Naggar, Walid

AU - Gill, Andrew

AU - Newnham, John

AU - Simmer, Karen

AU - Groom, Katie

AU - Weston, Philip

AU - Gullam, Joanna

AU - Patel, Harshad

AU - Koh, Guan

AU - Lui, Kei

AU - Marlow, Neil

AU - Morris, Scott

AU - Sehgal, Arvind

AU - Wallace, Euan

AU - Soll, Roger

AU - Young, Leslie

AU - Sweet, David

AU - Walker, Susan

AU - Watkins, Andrew

AU - Wright, Ian

AU - Osborn, David

AU - Simes, John

PY - 2018/5

Y1 - 2018/5

N2 - Systemic reviews have shown that delaying the time of umbilical cord clamping can improve outcomes of preterm newborns. One such study found enhanced placental transfusion through delayed cord clamping, cord-palpation, or a combination of the 2 practices caused a lower infection and mortality rate when compared with immediate clamping. Despite this recent body of evidence, concerns exist about harm from delayed resuscitation and hyperbilirubinemia causing current professional guidelines to vary significantly.This unblinded, randomized controlled trial compared the rates of a composite outcome of death and major morbidity between delayed and immediate cord clamping in infants born before 30 weeks of gestation. This study took place in 25 participating centers across 25 countries between 2010 and 2017. Eligible participants were randomly assigned to receive either immediate cord clamping defined as clamping within 10 seconds after delivery or delayed clamping defined as clamping at 60 or more seconds without cord palpation. The primary study outcomes were death, severe brain injury, severe retinopathy of prematurity, necrotizing enterocolitis, and late-onset sepsis, each diagnosed by 36 weeks of postmenstrual age. Tests for interaction were used to detect heterogeneity in the data between the primary outcomes across 3 subgroups: gestational age (= 27 week), sex, and method of delivery.A total of 1566 infants were deemed eligible for the study with 782 assigned to immediate cord clamping and 784 assigned to delayed cord clamping. The average times of clamping for the delayed and immediate cohorts were 60 seconds and 5 seconds, respectively. Adherence to the randomized protocol varied between the groups (94.9% for the immediate cohort, 73.2% in the delayed cohort) with the primary reason for nonadherence in the delayed cohort being clinical concern about infant well-being. No significant difference was found in the primary outcome at 36 weeks between immediate clamping (37.2%) and delayed clamping (37.0%) (relative risk [RR], 1.00; 95% confidence interval [CI], 0.88-1.13; P = 0.96). Death by 36 weeks postmenstrual age occurred in 9.0% of those in the immediate cohort and 6.4% in the delayed clamping group (RR, 0.69; 95% CI, 0.49-0.97; P = 0.03 unadjusted and 0.39 after post hoc adjustment for multiple secondary comparisons). More infants in the immediate clamping cohort received red blood cell tranfusions (60.5% vs 52.1% in the delayed clamping cohort). There were no significant differences in Apgar score, peak bilirubin level, or other major morbidities.The results of this study show that there is no significant difference on the rates of mortality or major morbidity at 36 weeks of gestation among preterm infants receiving immediate umbilical cord clamping versus delayed clamping.

AB - Systemic reviews have shown that delaying the time of umbilical cord clamping can improve outcomes of preterm newborns. One such study found enhanced placental transfusion through delayed cord clamping, cord-palpation, or a combination of the 2 practices caused a lower infection and mortality rate when compared with immediate clamping. Despite this recent body of evidence, concerns exist about harm from delayed resuscitation and hyperbilirubinemia causing current professional guidelines to vary significantly.This unblinded, randomized controlled trial compared the rates of a composite outcome of death and major morbidity between delayed and immediate cord clamping in infants born before 30 weeks of gestation. This study took place in 25 participating centers across 25 countries between 2010 and 2017. Eligible participants were randomly assigned to receive either immediate cord clamping defined as clamping within 10 seconds after delivery or delayed clamping defined as clamping at 60 or more seconds without cord palpation. The primary study outcomes were death, severe brain injury, severe retinopathy of prematurity, necrotizing enterocolitis, and late-onset sepsis, each diagnosed by 36 weeks of postmenstrual age. Tests for interaction were used to detect heterogeneity in the data between the primary outcomes across 3 subgroups: gestational age (= 27 week), sex, and method of delivery.A total of 1566 infants were deemed eligible for the study with 782 assigned to immediate cord clamping and 784 assigned to delayed cord clamping. The average times of clamping for the delayed and immediate cohorts were 60 seconds and 5 seconds, respectively. Adherence to the randomized protocol varied between the groups (94.9% for the immediate cohort, 73.2% in the delayed cohort) with the primary reason for nonadherence in the delayed cohort being clinical concern about infant well-being. No significant difference was found in the primary outcome at 36 weeks between immediate clamping (37.2%) and delayed clamping (37.0%) (relative risk [RR], 1.00; 95% confidence interval [CI], 0.88-1.13; P = 0.96). Death by 36 weeks postmenstrual age occurred in 9.0% of those in the immediate cohort and 6.4% in the delayed clamping group (RR, 0.69; 95% CI, 0.49-0.97; P = 0.03 unadjusted and 0.39 after post hoc adjustment for multiple secondary comparisons). More infants in the immediate clamping cohort received red blood cell tranfusions (60.5% vs 52.1% in the delayed clamping cohort). There were no significant differences in Apgar score, peak bilirubin level, or other major morbidities.The results of this study show that there is no significant difference on the rates of mortality or major morbidity at 36 weeks of gestation among preterm infants receiving immediate umbilical cord clamping versus delayed clamping.

U2 - 10.1097/01.ogx.0000534708.24689.e0

DO - 10.1097/01.ogx.0000534708.24689.e0

M3 - Editorial

VL - 73

SP - 265

EP - 266

JO - OBSTETRICAL & GYNECOLOGICAL SURVEY

JF - OBSTETRICAL & GYNECOLOGICAL SURVEY

SN - 0029-7828

IS - 5

ER -