The Effect of Delayed Cord Clamping on Moderate and Early Late-Preterm Infants

Arpitha Chiruvolu; Huanying Qin; Elizabeth T. Nguyen; Robert W. Inzer

doi:10.1055/s-0037-1607222

American Journal of Perinatology, Table of Contents

Am J Perinatol 2018; 35(03): 286-291
DOI: 10.1055/s-0037-1607222

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Effect of Delayed Cord Clamping on Moderate and Early Late-Preterm Infants

Arpitha Chiruvolu

¹Division of Neonatology, Department of Pediatrics, Baylor University Medical Center, Pediatrix Medical Group, Dallas, Texas

,

Huanying Qin

²Department of Quantitative Sciences, Baylor Scott & White Health Care System, Dallas, Texas

,

Elizabeth T. Nguyen

³Department of Medical Education, Texas A & M College of Medicine, Bryan, Texas

,

Robert W. Inzer

⁴Department of Obstetrics and Gynecology, Baylor University Medical Center, Dallas, Texas

› Author Affiliations

Abstract

Objective This study aims to evaluate the clinical consequences of protocol-driven delayed umbilical cord clamping (DCC) implementation in moderate and early late-preterm (MELP) infants born between 32^0/7 and 34^6/7 weeks gestation.

Study Design We conducted a prospective cohort study with a historic control cohort comparison. The prospective study period was 1 year when DCC was performed for 60 seconds duration (DCC cohort, n = 106). The study period for historic control cohort with no DCC was also 1 year before DCC implementation (historic cohort, n = 137).

Results The mean hematocrit at birth was significantly higher in the DCC cohort compared with the historic cohort (49.1 ± 14.9 vs. 45.7 ± 15.7; p = 0.01). Fewer infants in the DCC cohort were admitted to neonatal intensive care unit (NICU) on respiratory support compared with 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 with the historic cohort (2.8 vs. 14.6%; p = 0.002). There were no differences in the incidence of phototherapy or NICU length of stay (LOS) between groups.

Conclusion In MELP infants, DCC was associated with increased hematocrit and better respiratory transition at birth. DCC was not associated with increased phototherapy or NICU LOS.

Keywords

delayed umbilical cord clamping - moderate and early late-preterm infants - neonatal intensive care unit - phototherapy - length of stay

Full Text

References

References
1 Committee on Obstetric Practice. Committee opinion no. 684: delayed umbilical cord clamping after birth. Obstet Gynecol 2017; 129 (01) e5-e10
2 Sommers R, Stonestreet BS, Oh W. , et al. Hemodynamic effects of delayed cord clamping in premature infants. Pediatrics 2012; 129 (03) e667-e672
3 Aladangady N, McHugh S, Aitchison TC, Wardrop CA, Holland BM. Infants' blood volume in a controlled trial of placental transfusion at preterm delivery. Pediatrics 2006; 117 (01) 93-98
4 Mercer JS, Vohr BR, McGrath MM, Padbury JF, Wallach M, Oh W. Delayed cord clamping in very preterm infants reduces the incidence of intraventricular hemorrhage and late-onset sepsis: a randomized, controlled trial. Pediatrics 2006; 117 (04) 1235-1242
5 Ibrahim HM, Krouskop RW, Lewis DF, Dhanireddy R. Placental transfusion: umbilical cord clamping and preterm infants. J Perinatol 2000; 20 (06) 351-354
6 Backes CH, Rivera BK, Haque U. , et al. Placental transfusion strategies in very preterm neonates: a systematic review and meta-analysis. Obstet Gynecol 2014; 124 (01) 47-56
7 Backes CH, Huang H, Iams JD, Bauer JA, Giannone PJ. Timing of umbilical cord clamping among infants born at 22 through 27 weeks' gestation. J Perinatol 2016; 36 (01) 35-40
8 McDonald SJ, Middleton P, Dowswell T, Morris PS. Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. Cochrane Database Syst Rev 2013; (07) CD004074
9 Andersson O, Hellström-Westas L, Andersson D, Domellöf M. Effect of delayed versus early umbilical cord clamping on neonatal outcomes and iron status at 4 months: a randomised controlled trial. BMJ 2011; 343: d7157
10 Andersson O, Domellöf M, Andersson D, Hellström-Westas L. Effect of delayed vs early umbilical cord clamping on iron status and neurodevelopment at age 12 months: a randomized clinical trial. JAMA Pediatr 2014; 168 (06) 547-554
11 Andersson O, Lindquist B, Lindgren M, Stjernqvist K, Domellöf M, Hellström-Westas L. Effect of delayed cord clamping on neurodevelopment at 4 years of age: a randomized clinical trial. JAMA Pediatr 2015; 169 (07) 631-638
12 Natarajan G, Shankaran S. Short- and long-term outcomes of moderate and late preterm infants. Am J Perinatol 2016; 33 (03) 305-317
13 Strauss RG, Mock DM, Johnson KJ. , et al. A randomized clinical trial comparing immediate versus delayed clamping of the umbilical cord in preterm infants: short-term clinical and laboratory endpoints. Transfusion 2008; 48 (04) 658-665
14 Rabe H, Diaz-Rossello JL, Duley L, Dowswell T. Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes. Cochrane Database Syst Rev 2012; 8 (08) CD003248
15 Vermont Oxford Network. 2018 Manual of operations: Part 2. Data definitions & infant data forms. Release 22.0, Published April 2017. Available at: https://public.vtoxford.org/wp-content/uploads/2017/04/Manual_of_Operations_Part2_v22-1.pdf . Accessed June 01, 2017
16 International Committee for the Classification of Retinopathy of Prematurity. An International Committee for the Classification of Retinopathy of Prematurity. The international classification of Retinopathy of prematurity revisited. Arch Ophthalmol 2005; 123 (07) 991-999
17 Bell MJ, Ternberg JL, Feigin RD. , et al. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg 1978; 187 (01) 1-7
18 Papile L-A, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr 1978; 92 (04) 529-534
19 Ehrenkranz RA, Walsh MC, Vohr BR. , et al; National Institutes of Child Health and Human Development Neonatal Research Network. Validation of the National Institutes of Health consensus definition of bronchopulmonary dysplasia. Pediatrics 2005; 116 (06) 1353-1360
20 Committee on Obstetric Practice, American College of Obstetricians and Gynecologists. Committee opinion no.543: Timing of umbilical cord clamping after birth. Obstet Gynecol 2012; 120 (06) 1522-1526
21 Tarnow-Mordi WO, Duley L, Field D. , et al. Timing of cord clamping in very preterm infants: more evidence is needed. Am J Obstet Gynecol 2014; 211 (02) 118-123
22 Chiruvolu A, Tolia VN, Qin H. , et al. Effect of delayed cord clamping on very preterm infants. Am J Obstet Gynecol 2015; 213 (05) 676.e1-676.e7
23 Kerstjens JM, de Winter AF, Bocca-Tjeertes IF, ten Vergert EMJ, Reijneveld SA, Bos AF. Developmental delay in moderately preterm-born children at school entry. J Pediatr 2011; 159 (01) 92-98
24 Marks K, Hix-Small H, Clark K, Newman J. Lowering developmental screening thresholds and raising quality improvement for preterm children. Pediatrics 2009; 123 (06) 1516-1523
25 Bhutta AT, Cleves MA, Casey PH, Cradock MM, Anand KJ. Cognitive and behavioral outcomes of school-aged children who were born preterm: a meta-analysis. JAMA 2002; 288 (06) 728-737
26 Potijk MR, de Winter AF, Bos AF, Kerstjens JM, Reijneveld SA. Higher rates of behavioural and emotional problems at preschool age in children born moderately preterm. Arch Dis Child 2012; 97 (02) 112-117
27 Cheong JL, Doyle LW, Burnett AC. , et al. Association between moderate and late preterm birth and neurodevelopment and social-emotional development at age 2 years. JAMA Pediatr 2017; 171 (04) e164805
28 Schonhaut L, Armijo I, Pérez M. Gestational age and developmental risk in moderately and late preterm and early term infants. Pediatrics 2015; 135 (04) e835-e841
29 Walsh JM, Doyle LW, Anderson PJ, Lee KJ, Cheong JLY. Moderate and late preterm birth: effect on brain size and maturation at term-equivalent age. Radiology 2014; 273 (01) 232-240
30 Mercer JS, Erickson-Owens DA, Deoni S, Gilman C, Vohr B, Oh W, Padbury J. Effects of placental transfusion on ferritin and brain myelin volume at 4 months of age. E-PAS (abstract 3130.6)
31 Meier C, Middelanis J, Wasielewski B. , et al. Spastic paresis after perinatal brain damage in rats is reduced by human cord blood mononuclear cells. Pediatr Res 2006; 59 (02) 244-249
32 Kc A, Rana N, Målqvist M, Jarawka Ranneberg L, Subedi K, Andersson O. Effects of delayed umbilical cord clamping vs early clamping on anemia in infants at 8 and 12 months. A randomized clinical trial. JAMA Pediatr 2017; 171 (03) 264-270
33 Wickremasinghe AC, Kuzniewicz MW, Grimes BA, McCulloch CE, Newman TB. Neonatal phototherapy and infantile cancer. Pediatrics 2016; 137 (06) e20151353
34 Newman TB, Wickremasinghe AC, Walsh EM, Grimes BA, McCulloch CE, Kuzniewicz MW. Retrospective cohort study of phototherapy and childhood Cancer in Northern California. Pediatrics 2016; 137 (06) e20151354
35 Zahir F, Rabbani G, Khan RH, Rizvi SJ, Jamal MS, Abuzenadah AM. The pharmacological features of bilirubin: the question of the century. Cell Mol Biol Lett 2015; 20 (03) 418-447
36 Redmond A, Isana S, Ingall D. Relation of onset of respiration to placental transfusion. Lancet 1965; 1 (7380): 283-285
37 Kjeldsen J, Pedersen J. Relation of residual placental blood-volume to onset of respiration and the respiratory-distress syndrome in infants of diabetic and non-diabetic mothers. Lancet 1967; 1 (7483): 180-184
38 Hooper SB, Te Pas AB, Lang J. , et al. Cardiovascular transition at birth: a physiological sequence. Pediatr Res 2015; 77 (05) 608-614
39 Hooper SB, Binder-Heschl C, Polglase GR. , et al. The timing of umbilical cord clamping at birth: physiological considerations. Matern Health Neonatol Perinatol 2016; 2: 4
40 Usher RH, Saigal S, O'Neil A, Surainder Y, Chua L-B. Estimation of red blood cell volume in premature infants with and without respiratory distress syndrome. Biol Neonate 1975; 26 (3-4): 241-248