Analysis of All Preterm Infants Receiving Delayed Cord Clamping versus Immediate Clamping after Introducing a Delayed Cord Clamping Protocol

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Background: Delayed Cord Clamping (DCC) has been recommended by multiple medical bodies, including the American Congress of Obstetricians and Gynecologists, especially due to its benefits in preterm neonates, and is being adopted in many practices. Previous studies have shown benefits such as decreased blood transfusions, improved thermoregulation, decreased rates of intraventricular hemorrhage and necrotizing enterocolitis, however recent studies have found no improved morbidity or mortality.


Objectives: To evaluate whether there was an effect of delayed cord clamping on short term neonatal outcomes.

 Methods: IRB-exempt Quality Improvement prospective project was conducted to implement DCC for all infants born at Cooper University hospital via vaginal delivery or C-section with a gestational age of 24 to 35 weeks between July 15th, 2016 and July 14th, 2017. Infants were excluded if there was risk of fetal or maternal compromise. Infants meeting inclusion criteria underwent delayed cord clamping optimally for 45 seconds. Data including maternal and neonatal characteristics and resuscitation data, and neonatal outcomes was collected and compared with matching timeframe of July 15th, 2015 to July 14th, 2016. All infants who received DCC were compared to all infants who did not, regardless of inclusion or exclusion criteria.

 Results: Analysis of all infants that received DCC (N=90) versus immediate clamping (N=198) using chi square tests revealed a decreased need for initial respiratory support (p=0.062) when admitted to the NICU, including less patients requiring mechanical ventilation (25.6% vs 37.4%, p=0.049). Admission hemoglobin levels were higher in the DCC group (16.08 vs 15.29 mg/dL, p=0.033), while the need for packed red blood cells during entire stay decreased (29% vs 39%, p=0.085). However, there was a trend for an increase in bronchopulmonary dysplasia (20% vs 15%, p=0.36), necrotizing enterocolitis (7% vs 5%, p=0.36), sepsis (20% vs 17%, p=0.56) and intraventricular hemorrhage (18% vs 13%, p=0.20) in the DCC group that was not statistically significant. There was no difference in mortality (6.7% vs 7.1%, p=0.90).

 Conclusion: Infants that received DCC required less initial respiratory support, less mechanical ventilation and had higher initial hemoglobin levels. However, no significant differences were seen in morbidities or mortality with or without DCC, which aligns with recent literature. Benefits of DCC followed some expected trends, but also results which warrant further investigation of subsets of infants benefiting from DCC or who may be adversely affected by DCC. 

Cooper University Hospital
Cooper Medical School of Rowan University

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