Preterm infants benefit from delayed umbilical cord clamping [Classics Series]
1. Preterm infants randomized to delayed cord clamping for 30 seconds after birth required less cardiorespiratory intervention, less supplemental oxygen and fewer blood transfusions compared to controls.
Original Date of Publication: January 1993
Study Rundown: Prematurity is a major contributor to neonatal morbidity, mortality and healthcare costs in the United States. As of 2015, Over 11% of all births in the United States are preterm. Preterm infants are most notably at increased risk for respiratory complications as a result of lack of surfactant production related to delivery prior to completion of fetal lung maturation. Due to concerns for respiratory compromise or even failure following preterm birth, preterm infants have traditionally been handed off to awaiting neonatal intensive care unit staff as soon as possible following delivery. This urgency has translated to immediate cord clamping following delivery. Additionally, there has historically been a greater abundance of teachings detailing adverse neonatal events associated with delayed cord clamping (e.g. volume overload, polycythemia, hyperbilirubinemia) compared to adverse events associated with immediate cord clamping (e.g. hypovolemia). Despite this traditional dictum, there have been numerous and repeated claims that delayed cord clamping is particularly beneficial among preterm infants. In the present study, authors conduct the first randomized investigation to determine whether holding the preterm infant in a position to facilitate placental transfusion for 30 seconds after delivery prior to cord clamping is associated with fetal benefit.
This landmark study demonstrated that delayed umbilical cord clamping was associated with numerous benefits to the preterm neonate and stimulated additional investigations further characterizing these benefits. Strengths included randomized design and numerous markers of respiratory, cardiac and hematologic function. Weaknesses included a single-site investigation and small sample size of 36 infants.
Dr. Alan Peaceman, MD, talks to 2 Minute Medicine: Northwestern University School of Medicine; Chief, Division of Obstetrics and Gynecology-Maternal Fetal Medicine.
“This landmark trial was the first to demonstrate that preterm infants randomized to delayed cord clamping experienced less severe respiratory impairments and required fewer blood transfusions. Findings stimulated additional prospective investigation and contributed to the determination that delayed cord clamping is associated with health benefits for the preterm neonate.”
In-Depth [randomized trial]: A total of 36 women from 27 until 33 weeks gestation were randomized to delayed cord clamping for 30 seconds (n=17, “delayed cord clamping”) or conventional management with immediate cord clamping (n=19, “controls”). Primary outcomes were markers of neonatal circulation and oxygenation and included initial red blood cell volume, peak serum bilirubin, need for blood transfusion and markers of respiratory impairment. The majority of both groups of infants (n=13 for both) required mechanical ventilation.
Preterm infants randomized to delayed cord clamping had higher minimum arterial-alveolar oxygen tension ratios, a marker of cardiopulmonary function, from day 1 of life (p = 0.02), required fewer days of supplemental oxygen (3 vs. 10 median days, respectively, p < 0.01) and less commonly required high fractions of supplemental oxygen (p < 0.01) compared to controls. Preterm infants in the control group required a higher median volume of transfused red blood cells (23mL vs. 0mL, respectively, p = 0.03) compared to infants in the delayed clamping group.
Image: PD
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