Effect of delayed cord clamping on very preterm twins.

BACKGROUND: The very preterm infants of twin births may particularly benefit from delayed cord clamping (DCC) as the likelihood of unfavorable outcome is greater compared to singletons. Unfortunately, there is paucity of available information regarding safety and efficacy of DCC in this group. OBJECTIVE: To report the clinical consequences of delayed cord clamping (DCC) in very preterm twins, born between 230/7 and 316/7 weeks gestation. STUDY DESIGN: In this pre and post intervention retrospective cohort study, we compared 30 very preterm infants born from 15 twin deliveries during historic study period to 32 very preterm infants born from 16 twin deliveries during DCC study period. During historic study period (August 19, 2013 to January 31, 2015), infants included were eligible to receive DCC, but their cords were immediately clamped. DCC study period (February 1, 2015 to January 31, 2017) included infants who had DCC performed for 60 s after birth. RESULTS: The Apgar scores and other resuscitation variables were similar between both groups. After adjusting for gestational age and mode of delivery, significantly fewer infants in the DCC cohort needed red blood cell (RBC) transfusions in first week of life compared to the historic cohort (15.6% vs. 43.3%; P = 0.03). Death and other major neonatal outcomes were similar between both groups. CONCLUSION: DCC in very preterm twins was safe, feasible and not associated with any adverse neonatal outcomes compared to early cord clamping. DCC was associated with a significant reduction in early RBC transfusions.

Effect of delay in cord clamping 45 versus 60 s on very preterm singleton infants.

BACKGROUND: In the range of timing suggested by American College of Obstetricians and Gynecologists 30 to 60 s, preterm infants may potentially derive more short and long-term benefits with delayed cord clamping (DCC) for at least 60 s. However, there are concerns with longer resuscitation delay in this vulnerable population. OBJECTIVE: To compare the clinical consequences of 45 versus 60 s delay in umbilical cord clamping in singleton infants born between 230/7 to 316/7 weeks gestation. STUDY DESIGN: We implemented DCC process in very preterm singleton infants, initially for 45 s and later, modified the policy to increase the delay to 60 s. We compared the infants born and received DCC (n = 60) during the 45 s study period (DCC-45 cohort), from Aug.19, 2013, to Aug.18, 2014 to the infants born and received DCC (n = 63) during the 60 s study period (DCC-60 cohort), from Feb.1, 2015, to Jan.31, 2016. RESULTS: The incidence of necrotizing enterocolitis in DCC-60 cohort was 0% compared to 8% in the DCC-45 cohort (P = 0.02). Similarly, incidence of culture-positive sepsis was significantly lower in the DCC-60 cohort compared to DCC-45 cohort (8% versus 18%; P = 0.04). Incidence of mortality and other major morbidities were similar between both groups. Length of stay was significantly lower in DCC-60 cohort compared to DCC-45 cohort. CONCLUSION: DCC for 60 s in very preterm singleton infants was safe, feasible and not associated with any adverse maternal or neonatal short-term outcomes compared to DCC for 45 s.

The Effect of Delayed Cord Clamping on Moderate and Early Late-Preterm Infants.

OBJECTIVE: This study aims to evaluate the clinical consequences of protocol-driven delayed umbilical cord clamping (DCC) implementation in moderate and early late-preterm (MELP) infants born between 320/7 and 346/7 weeks gestation. STUDY DESIGN: We conducted a prospective cohort study with a historic control cohort comparison. The prospective study period was 1 year when DCC was performed for 60 seconds duration (DCC cohort, n = 106). The study period for historic control cohort with no DCC was also 1 year before DCC implementation (historic cohort, n = 137). RESULTS: The mean hematocrit at birth was significantly higher in the DCC cohort compared with the historic cohort (49.1 ± 14.9 vs. 45.7 ± 15.7; p = 0.01). Fewer infants in the DCC cohort were admitted to neonatal intensive care unit (NICU) on respiratory support compared with the historic cohort (17.9 vs. 29.9%; p = 0.04). The incidence of respiratory distress syndrome was significantly lower in the DCC cohort compared with the historic cohort (2.8 vs. 14.6%; p = 0.002). There were no differences in the incidence of phototherapy or NICU length of stay (LOS) between groups. CONCLUSION: In MELP infants, DCC was associated with increased hematocrit and better respiratory transition at birth. DCC was not associated with increased phototherapy or NICU LOS.

Effect of delayed cord clamping on very preterm infants.

OBJECTIVE: Despite significant proposed benefits, delayed umbilical cord clamping (DCC) is not practiced widely in preterm infants largely because of the question of feasibility of the procedure and uncertainty regarding the magnitude of the reported benefits, especially intraventricular hemorrhage (IVH) vs the adverse consequences of delaying the neonatal resuscitation. The objective of this study was to determine whether implementation of the protocol-driven DCC process in our institution would reduce the incidence of IVH in very preterm infants without adverse consequences. STUDY DESIGN: We implemented a quality improvement process for DCC the started in August 2013 in infants born at ≤32 weeks' gestational age. Eligible infants were left attached to the placenta for 45 seconds after birth. Neonatal process and outcome data were collected until discharge. We compared infants who received DCC who were born between August 2013 and August 2014 with a historic cohort of infants who were born between August 2012 and August 2013, who were eligible to receive DCC, but whose cord was clamped immediately after birth, because they were born before the protocol implementation. RESULTS: DCC was performed on all the 60 eligible infants; 88 infants were identified as historic control subjects. Gestational age, birthweight, and other demographic variables were similar between both groups. There were no differences in Apgar scores or admission temperature, but significantly fewer infants in the DCC cohort were intubated in delivery room, had respiratory distress syndrome, or received red blood cell transfusions in the first week of life compared with the historic cohort. A significant reduction was noted in the incidence of IVH in the DCC cohort compared with the historic control group (18.3% vs 35.2%). After adjustment for gestational age, an association was found between the incidence of IVH and DCC with IVH was significantly lower in the DCC cohort compared with the historic cohort; an odds ratio of 0.36 (95% confidence interval, 0.15-0.84; P < .05). There were no significant differences in deaths and other major morbidities. CONCLUSION: DCC, as performed in our institution, was associated with significant reduction in IVH and early red blood cell transfusions. DCC in very preterm infants appears to be safe, feasible, and effective with no adverse consequences.