Download PDF
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
1   Division of Neonatology, Department of Pediatrics, Baylor University Medical Center, Pediatrix Medical Group, Dallas, Texas
,
Huanying Qin
2   Department of Quantitative Sciences, Baylor Scott & White Health Care System, Dallas, Texas
,
Elizabeth T. Nguyen
3   Department of Medical Education, Texas A & M College of Medicine, Bryan, Texas
,
Robert W. Inzer
4   Department of Obstetrics and Gynecology, Baylor University Medical Center, Dallas, Texas
› Author Affiliations Funding This study received a faculty research grant from the Baylor University Medical Center, Dallas, TX.
Further Information

Publication History

30 April 2017

28 August 2017

Publication Date:
28 September 2017 (online)

    Permissions and Reprints

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 320/7 and 346/7 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
 

  • References

  • 1 Committee on Obstetric Practice. Committee opinion no. 684: delayed umbilical cord clamping after birth. Obstet Gynecol 2017; 129 (01) e5-e10
    CrossrefPubMedGoogle Scholar
  • 2 Sommers R, Stonestreet BS, Oh W. , et al. Hemodynamic effects of delayed cord clamping in premature infants. Pediatrics 2012; 129 (03) e667-e672
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 5 Ibrahim HM, Krouskop RW, Lewis DF, Dhanireddy R. Placental transfusion: umbilical cord clamping and preterm infants. J Perinatol 2000; 20 (06) 351-354
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 12 Natarajan G, Shankaran S. Short- and long-term outcomes of moderate and late preterm infants. Am J Perinatol 2016; 33 (03) 305-317
    Article in Thieme ConnectPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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)
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 33 Wickremasinghe AC, Kuzniewicz MW, Grimes BA, McCulloch CE, Newman TB. Neonatal phototherapy and infantile cancer. Pediatrics 2016; 137 (06) e20151353
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 36 Redmond A, Isana S, Ingall D. Relation of onset of respiration to placental transfusion. Lancet 1965; 1 (7380): 283-285
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 38 Hooper SB, Te Pas AB, Lang J. , et al. Cardiovascular transition at birth: a physiological sequence. Pediatr Res 2015; 77 (05) 608-614
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar