OBJECTIVE. This study compared the effects of immediate (ICC) and delayed (DCC) cord clamping on very low birth weight (VLBW) infants on 2 primary variables: bronchopulmonary dysplasia (BPD) and suspected necrotizing enterocolitis (SNEC). Other outcome variables were late-onset sepsis (LOS) and intraventricular hemorrhage (IVH).
STUDY DESIGN. This was a randomized, controlled unmasked trial in which women in labor with singleton fetuses <32 weeks’ gestation were randomly assigned to ICC (cord clamped at 5–10 seconds) or DCC (30–45 seconds) groups. Women were excluded for the following reasons: their obstetrician refused to participate, major congenital anomalies, multiple gestations, intent to withhold care, severe maternal illnesses, placenta abruption or previa, or rapid delivery after admission.
RESULTS. Seventy-two mother/infant pairs were randomized. Infants in the ICC and DCC groups weighed 1151 and 1175 g, and mean gestational ages were 28.2 and 28.3 weeks, respectively. Analyses revealed no difference in maternal and infant demographic, clinical, and safety variables. There were no differences in the incidence of our primary outcomes (BPD and suspected NEC). However, significant differences were found between the ICC and DCC groups in the rates of IVH and LOS. Two of the 23 male infants in the DCC group had IVH versus 8 of the 19 in the ICC group. No cases of sepsis occurred in the 23 boys in the DCC group, whereas 6 of the 19 boys in the ICC group had confirmed sepsis. There was a trend toward higher initial hematocrit in the infants in the DCC group.
CONCLUSIONS. Delayed cord clamping seems to protect VLBW infants from IVH and LOS, especially for male infants.
Where was this study done? I'm trying to cite it in my table of evidence.
Thank you and kind regards.
Mercer JS and colleagues have done a well designed study to demonstrate effects of delayed cord clamping in very preterm infants. The sample size was too small to demonstrate the difference in the primary outcome BPD, but the positive trends for DCC merits further studies. Given the lack of adverse events in the DCC group, some might consider adopting this practice until definitive studies are completed.
Conflict of Interest:
None declared
Mercer and colleagues found a statistically significant decrease in late onset infection and intraventricular hemorrhage (IVH) in a group of premature infants with delayed cord clamping compared with a group with immediate cord clamping. They point out that their results are consistent with a recent Cochrane Review and propose a reasonable explanation for the differences that they observed. However, it is interesting to note that the level of significance for both comparisons (p = 0.03) was relatively small. While the data was grouped and analyzed appropriately, the study did involve multiple comparisons and I would question how confident one can be that the differences observed here were not actually due to chance alone. Also, with respect to the observed differences in IVH rates, almost all of the IVH that occurred was Grade 1 or Grade 2, which is clearly a reflection of the excellent obstetrical and neonatal care provided to these infants. While a larger study might have demonstrated a statistically significant difference in Grade 3 and Grade 4 IVH, in this study no statistically significant difference in the rate of severe IVH between the groups was demonstrated.
Conflict of Interest:
None declared