Background: Delayed umbilical cord clamping (DCC) appears to be beneficial for preterm and term infants. In very preterm infants DCC improves hemodynamic stability after birth and decreases major neonatal morbidities, such as intraventricular hemorrhage (IVH) and necrotizing enterocolitis (NEC). In term infants DCC increases hemoglobin levels at birth and improves iron stores in the first several months of life. All of these have favorable effect on infant developmental outcomes. But, none of the published studies specifically focused on moderately preterm infants born between gestational ages 32 to 35 weeks. The major neonatal morbidities like IVH and NEC are not common in these infants, but they are at increased risk for iron deficiency anemia and adverse developmental outcomes compared to late preterm and term infants. Also, there are concerns that DCC may increase incidence of phototherapy and hospital length of stay (LOS) in these infants. In February 2015, we modified our DCC protocol to include moderately preterm infants. We hypothesized that DCC for 60 seconds after birth would increase the hematocrit at birth compared to a historical control group and would not be associated with increase in the incidence of phototherapy or LOS in these infants. Objective: The objective of this study was to evaluate the clinical consequences of a protocol-driven DCC implementation in moderately preterm infants. Study design: We conducted a prospective cohort study with a historical control comparison. The prospective study period was 1 year, from February 1st 2015 to January 31st 2016 when DCC was performed for 60 seconds. The study period for historic cohort was also I year, from February 1st 2014 to January 31st 2015. During this period umbilical cord was immediately clamped after birth. Results: The 106 infants in DCC cohort were compared to 137 infants in the historic cohort. There were no differences in maternal and infant characteristics between both groups. Similarly, there were no differences in 1 and 5 minute Apgar scores and incidence of hypothermia. The mean hematocrit at birth was significantly higher in the DCC cohort compared to the historic cohort (49.1 ± 14.9 vs. 45.7 ± 15.7; P=0.01). Fewer infants in the DCC cohort were admitted on respiratory support (intubation or CPAP) compared to 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 to the historic cohort (2.8% vs 14.6%; P=0.002). There was no difference in the incidence of phototherapy or LOS between both groups. Conclusion: In moderately preterm infants, DCC for 60 seconds is associated with increased hematocrit at birth and beneficial short term with regards to better respiratory transition. It is not associated with increased phototherapy or LOS.
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Section on Neonatal-Perinatal Medicine Program: Day 1| May 01 2018
Effect of Delayed Cord Clamping on Moderately Preterm Infants
Pediatrics (2018) 142 (1_MeetingAbstract): 153.
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Arpitha Chiruvolu; Effect of Delayed Cord Clamping on Moderately Preterm Infants. Pediatrics May 2018; 142 (1_MeetingAbstract): 153. 10.1542/peds.142.1MA2.153
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