Himanshu Popat1, Kristy P Robledo2, Lucille Sebastian2, Nicholas Evans3, Andrew Gill4, Martin Kluckow5, Sanjay Sinhal6, Koert de Waal7, William Tarnow-Mordi2, David Osborn8. 1. Department of Neonatology, Children's Hospital at Westmead, New South Wales, Australia; University of Sydney, Sydney, New South Wales, Australia. 2. University of Sydney, Sydney, New South Wales, Australia; NHMRC Clinical Trials Centre, University of Sydney, Camperdown, New South Wales, Australia. 3. University of Sydney, Sydney, New South Wales, Australia; Department of Neonatology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia. 4. Centre for Neonatal Education and Research, University of Western Australia, Western Australia, Australia. 5. University of Sydney, Sydney, New South Wales, Australia; Department of Neonatology, Royal North Shore Hospital, St Leonards, New South Wales, Australia. 6. Department of Neonatology, Flinders Medical Centre, Bedford Park, South Australia, Australia. 7. Department of Neonatology, John Hunter Children's Hospital, New Lambton, New South Wales, Australia. 8. University of Sydney, Sydney, New South Wales, Australia; Department of Neonatology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia. Electronic address: david.osborn@sydney.edu.au.
Abstract
OBJECTIVE: To determine whether delayed cord clamping improves systemic blood flow compared with immediate cord clamping in very preterm infants in the first 24 hours. STUDY DESIGN:Women delivering at <30 weeks' gestation at 5 tertiary centers were randomized to receive immediate cord clamping (<10 seconds) or delayed cord clamping (≥60 seconds). Echocardiography and cardiorespiratory data were collected at 3, 9, and 24 hours after birth. The primary outcome was mean lowest superior vena cava (SVC) flow. RESULTS: Of 266 infants enrolled, 133 were randomized toimmediate cord clamping and 133 to delayed cord clamping. The 2 groups were similar at baseline, including mean gestation (immediate cord clamping 28 weeks vs delayed cord clamping 28 weeks) and birth weight (immediate cord clamping 1003 g vs delayed cord clamping 1044 g). There was no significant difference between groups in the primary outcome of mean lowest SVC flow (immediate cord clamping 71.4 mL/kg/min [SD 28.1] vs delayed cord clamping 70.2 mL/kg/min [SD 26.9]; P = .7). For secondary outcomes, hemoglobin increased by 0.9 g/dL at 6 hours in the group with delayed cord clamping (95% CI 3.9, 14.4; P = .0005, adjusted for baseline). The group with delayed cord clamping had lower right ventricular output (-21.9 mL/kg/min, 95% CI -39.0, -4.7; P = .01). Rates of treated hypotension, ductus arteriosus size and shunt direction, and treatment of the ductus arteriosus were similar. CONCLUSIONS:Delayed cord clamping had no effect on systemic blood flow measured as mean lowest SVC flow in the first 24 hours in infants <30 weeks' gestation. TRIAL REGISTRATION: Australia New Zealand Clinical Trials Registry: ACTRN12610000633088.
RCT Entities:
OBJECTIVE: To determine whether delayed cord clamping improves systemic blood flow compared with immediate cord clamping in very preterm infants in the first 24 hours. STUDY DESIGN:Women delivering at <30 weeks' gestation at 5 tertiary centers were randomized to receive immediate cord clamping (<10 seconds) or delayed cord clamping (≥60 seconds). Echocardiography and cardiorespiratory data were collected at 3, 9, and 24 hours after birth. The primary outcome was mean lowest superior vena cava (SVC) flow. RESULTS: Of 266 infants enrolled, 133 were randomized to immediate cord clamping and 133 to delayed cord clamping. The 2 groups were similar at baseline, including mean gestation (immediate cord clamping 28 weeks vs delayed cord clamping 28 weeks) and birth weight (immediate cord clamping 1003 g vs delayed cord clamping 1044 g). There was no significant difference between groups in the primary outcome of mean lowest SVC flow (immediate cord clamping 71.4 mL/kg/min [SD 28.1] vs delayed cord clamping 70.2 mL/kg/min [SD 26.9]; P = .7). For secondary outcomes, hemoglobin increased by 0.9 g/dL at 6 hours in the group with delayed cord clamping (95% CI 3.9, 14.4; P = .0005, adjusted for baseline). The group with delayed cord clamping had lower right ventricular output (-21.9 mL/kg/min, 95% CI -39.0, -4.7; P = .01). Rates of treated hypotension, ductus arteriosus size and shunt direction, and treatment of the ductus arteriosus were similar. CONCLUSIONS: Delayed cord clamping had no effect on systemic blood flow measured as mean lowest SVC flow in the first 24 hours in infants <30 weeks' gestation. TRIAL REGISTRATION: Australia New Zealand Clinical Trials Registry: ACTRN12610000633088.
Authors: Douglas A Blank; Graeme R Polglase; Martin Kluckow; Andrew William Gill; Kelly J Crossley; Alison Moxham; Karyn Rodgers; Valerie Zahra; Ishmael Inocencio; Fiona Stenning; Domeic A LaRosa; Peter G Davis; Stuart B Hooper Journal: Arch Dis Child Fetal Neonatal Ed Date: 2017-12-05 Impact factor: 5.747
Authors: Fiona J Stenning; Stuart B Hooper; Martin Kluckow; Kelly J Crossley; Andrew W Gill; Euan M Wallace; Arjan B Te Pas; Domenic LaRosa; Graeme R Polglase Journal: Front Pediatr Date: 2019-10-09 Impact factor: 3.418
Authors: David van Laere; Bart van Overmeire; Samir Gupta; Afif El-Khuffash; Marilena Savoia; Patrick J McNamara; Christoph E Schwarz; Willem P de Boode Journal: Pediatr Res Date: 2018-07 Impact factor: 3.756