Background: Delayed cord clamping (DCC) has been recommended by multiple governing medical organizations, including the AAP and ACOG, for both term and preterm infants. The effects of DCC on developmental outcomes of preterm infants remain unclear. Close follow up of developmental outcomes is crucial for preterm infants, who are at a greater risk of developmental delays and impairments. Studies have also shown that socioeconomic factors, such as race, ethnicity, insurance status, maternal education, marital status, and wealth have an impact on the developmental outcomes of preterm infants.
Objective: To evaluate the effect of DCC on developmental outcomes of preterm infants and determine whether social factors have a confounding influence.
Design/Methods: A retrospective chart review of preterm infants 23 0/7-34 6/7 weeks gestation born 5/1/2016 to 3/31/2018 was conducted. Inclusion criteria was attending a neonatal follow-up visit or well-child visit in our hospital at 18-24 months corrected age (CGA). DCC was defined as clamping the umbilical cord 45 seconds after birth. Bayley Scales of Infant and Toddler Development, 3rd Ed. (BSID-III) conducted at 18-24 months CGA was used to assess developmental outcomes. Developmental milestones based on the Bright Futures Guidelines for Health Supervision of Infants, Children and Adolescents (AAP) were recorded at the 24-month well-child visit (18-24 months CGA). Social factors included race, language preference, maternal age, employment status, and insurance type, single or two-parent household, and distance of the home to hospital.
Results: Of the 318 preterm infants evaluated, 127 (39.9%) underwent developmental evaluation at 18-24 months CGA, and 68 (21.4%) had BSID-III scores. Of the 127 infants who underwent any developmental evaluation, 65 (51.2%) received DCC, and of the 68 with BSID-III scores, 35 (51.5%) received DCC. After accounting for the social confounders, there was no significant relationship between DCC and Bayley composite scores (Motor – β = 0.058, P = 0.724; Language – β = -0.049, P = 0.769; Cognitive – β = 0.083, P = 0.557). Infants who received DCC reached a mean percentage in the developmental milestones of 80.37 ± 23.57 while those with no DCC had a mean of 74.84 ± 27.26, p = 0.391. There was no significant difference between the DCC and non-DCC infants in their motor and language/cognitive developmental milestones.
Conclusion: In our cohort, after accounting for social confounders, the developmental outcomes of preterm infants who received DCC did not significantly differ from those who did not receive DCC. There was a slight trend for improved developmental milestones in those who received DCC, but this was not seen on BSID-III.
