Delayed versus Immediate Cord Clamping in Preterm Infants
Authors
William O. Tarnow-Mordi, University of Sydney
Jonathan Morris, University of Sydney
Adrienne Kirby, University of Sydney
K Robledo, University of Sydney
Lisa Askie, University of Sydney
Rebecca Brown, University of SydneyFollow
Nicholas Evans, University of Sydney
Sarah Finlayson, University of Sydney
Michael Fogarty, University of Sydney
Val Gebski, University of Sydney
Alpana Ghadge, University of Sydney
Wendy Hague, University of Sydney
David Isaacs, University of Sydney
Michelle Jeffery, University of Sydney
Anthony Keech, University of Sydney
Martin Kluckow, University of Sydney
Himanshu Popat, University of Sydney
Lucille Sebastian, University of Sydney
Kjersti Aagaard, Baylor College Of Medicine
Michael Belfort, Baylor College Of Medicine
Mohan Pammi, Baylor College Of Medicine
Mohamed E. Abdel-Latif, Australian National University
Graham Reynolds, Australian National University
Shabina Ariff, Aga Khan University Hospital
Lumaan Sheikh, Aga Khan University Hospital
Yan Chen, University of Sydney
Paul Colditz, University of Queensland
Helen Liley, University of Queensland
Margo Pritchard, University of Queensland
Daniele De Luca, Hôpital Antoine-Beclere
Koert de Waal, University of Newcastle
Peta Forder, University of Newcastle
Lelia Duley, University of Nottingham
Walid El-Naggar, Dalhousie University
Andrew Gill, University of Western Australia
John Newnham, University of Western Australia
Karen Simmer, University of Western Australia
Katie Groom, James Cook University, University of Auckland
Philip Weston, University of Otago
Joanna Gullam, University of Otago
Harshad Patel, University of Otago
Guan Koh, James Cook University
Kei Lui, University of New South Wales
Neil Marlow, University College London
Scott Morris, Flinders University
Arvind Sehgal, Monash University
Euan M. Wallace, Monash University
Roger Soll, University of Vermont
Leslie Young, University of Vermont
David Sweet, Royal Jubilee Maternity Hospital
Susan Walker, University of Melbourne
Andrew Watkins, Mercy Hospital for Women
Ian M. R Wright, University of WollongongFollow
David Osborn, University of Sydney
John E. Simes, University of SydneyFollow
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 (=10 seconds after delivery) or delayed clamping (=60 seconds after delivery). The primary composite outcome was death or major morbidity (defined as severe brain injury on postnatal ultrasonography, severe retinopathy of prematurity, necrotizing enterocolitis, or late-onset sepsis) by 36 weeks of postmenstrual age. Analyses were performed on an intention-to-treat basis, accounting for multiple births. 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.
Publication Details
Tarnow-Mordi, W., Morris, J., Kirby, A., Robledo, K., Askie, L., Brown, R., Evans, N., Finlayson, S., Fogarty, M., Gebski, V., Ghadge, A., Hague, W., Isaacs, D., Jeffery, M., Keech, A., Kluckow, M., Popat, H., Sebastian, L., Aagaard, K., Belfort, M., Pammi, M., Abdel-Latif, M., Reynolds, G., Ariff, S., Sheikh, L., Chen, Y., Colditz, P., Liley, H., Pritchard, M., De Luca, D., de Waal, K., Forder, P., Duley, L., El-Naggar, W., Gill, A., Newnham, J., Simmer, K., Groom, K., Weston, P., Gullam, J., Patel, H., Koh, G., Lui, K., Marlow, N., Morris, S., Sehgal, A., Wallace, E., Soll, R., Young, L., Sweet, D., Walker, S., Watkins, A., Wright, I., Osborn, D. & Simes, J. (2017). Delayed versus Immediate Cord Clamping in Preterm Infants. New England Journal of Medicine, 377 (25), 2445-2455.