Randomized study of delayed cord clamping of 30 to 60 seconds in the larger infant born preterm

1. Among preterm infants, the delaying of cord clamping for 60 seconds was associated with an increased hematocrit when compared to clamping at 30 seconds.

2. The greatest absolute increase in hematocrit between the two groups was seen among infants born at less than 31 weeks.

Evidence Level Rating: 2 (Good)

Delayed cord clamping (DCC) is a widely accepted practice in neonatal care because it increases blood flow from mother to fetus and facilitates the cardiorespiratory transition. Many professional organizations, including the World Health Organization and the American College of Obstetrics and Gynecology, recommend DCC for at least 30 to 60 seconds after birth when appropriate. Some providers, however, are hesitant to delay cord clamping for fear of delaying resuscitation and hyperbilirubinemia. This randomized controlled trial compared 50 infants (mean [SD] gestational age = 32.7 [1.6] weeks) clamped at 30 seconds with 55 infants (mean [SD] gestational age = 33.2 [2.1] weeks) clamped at 60 seconds born to mothers with threatened preterm delivery between 28 and 34^6/7 weeks estimated gestational age. The primary objective was to determine whether DCC for 30 or 60 seconds would be associated with a difference in hematocrit of 3%. Secondary objectives included the impact of DCC on other metrics such as Apgar scores, initial and 6-hour heart rate, and initial temperature, among others. Initial hematocrit was 49.7±5.2% among the 30-second group and 52.5±6.1% among the 60-second group (p = 0.006). Subgroup analysis revealed that for infants born at <31 weeks (n = 16), hematocrit increased from 45.9±6.2% among the 30-second group to 52.7±7.6% among the 60-second group (p = 0.03), while for infants born at ≥31 weeks (n = 89), hematocrit increased from 50.1±4.8% among the 30-second group to 52.5±5.9% among the 60-second group (p = 0.02). Between the two groups, no secondary objectives measured were statistically significant, and there were no obvious adverse effects attributable to the intervention. This study adds to the growing evidence that supports DCC among preterm infants because of its immediate clinical benefits and positive impact on hematocrit.

Click to read the study in Journal of Pediatrics

Image: PD

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