Marinela Grabovac1, Marc Beltempo2, Abhay Lodha3, Candace O'Quinn4, Ariadna Grigoriu5, Keith Barrington6, Junmin Yang7, Sarah D McDonald8. 1. Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario. Electronic address: marinela.grabovac@medportal.ca. 2. Department of Pediatrics, Montreal's Children's Hospital - McGill University Health Centre, Montréal, Québec. 3. Department of Pediatrics and Community Health Sciences, University of Calgary, Foothills Medical Centre, Calgary, Alberta. 4. Department of Obstetrics and Gynecology, Section of Maternal Fetal Medicine, Foothills Medical Centre, University of Calgary, Alberta. 5. Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, The Moncton Hospital, Moncton, New Brunswick. 6. Department of Pediatrics, University of Montréal, Montréal, Québec. 7. Maternal-Infant Care Research Center, Mount Sinai Hospital, Toronto, Ontario. 8. Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario; Division of Maternal Fetal Medicine, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario; Department of Radiology, McMaster University, Hamilton, ON, Canada.
Abstract
OBJECTIVE: To determine if deferred cord clamping (DCC) compared with early cord clamping (ECC) was associated with reduction in death and/or severe neurological injury among twins born at <30 weeks of gestation. STUDY DESIGN: We performed a retrospective cohort study including all liveborn twins <30 weeks admitted to a tertiary-level neonatal intensive care unit (NICU) in Canada between 2015-2018 using the Canadian Neonatal/Preterm Birth Network database. We compared DCC ≥30 seconds versus ECC <30 seconds. Our primary outcome was a composite of death and/or severe neurological injury (severe intraventricular hemorrhage grade III/IV and/or periventricular leukomalacia). Secondary outcomes included neonatal morbidity and health care utilization outcomes. We calculated adjusted odds ratios (aOR) and β-coefficients for categorical and continuous variables, along with 95% confidence intervals (CI). Models were fitted with generalized estimated equations accounting for twin correlation. RESULTS: We included 1597 twins [DCC: 624 (39.1%); ECC: 973 (60.9%)]. Death/severe neurological injury occurred in 17.8% (N=111) and 21.7% (N=211) of twins who received DCC and ECC, respectively. The rate of death/severe neurological injury did not significantly differ between DCC and ECC groups (aOR 1.07, 95% CI 0.78-1.47). DCC was associated with reduced blood transfusions (adjusted β coefficient -0.49, 95% CI -0.86, -0.12) and NICU length of stay (adjusted β coefficient -4.17, 95% CI -8.15, -0.19). CONCLUSIONS: The primary composite outcome of death and/or severe neurological injury did not differ between twins born at <30 weeks of gestation who received DCC and ECC, but DCC was associated with some benefits.
OBJECTIVE: To determine if deferred cord clamping (DCC) compared with early cord clamping (ECC) was associated with reduction in death and/or severe neurological injury among twins born at <30 weeks of gestation. STUDY DESIGN: We performed a retrospective cohort study including all liveborn twins <30 weeks admitted to a tertiary-level neonatal intensive care unit (NICU) in Canada between 2015-2018 using the Canadian Neonatal/Preterm Birth Network database. We compared DCC ≥30 seconds versus ECC <30 seconds. Our primary outcome was a composite of death and/or severe neurological injury (severe intraventricular hemorrhage grade III/IV and/or periventricular leukomalacia). Secondary outcomes included neonatal morbidity and health care utilization outcomes. We calculated adjusted odds ratios (aOR) and β-coefficients for categorical and continuous variables, along with 95% confidence intervals (CI). Models were fitted with generalized estimated equations accounting for twin correlation. RESULTS: We included 1597 twins [DCC: 624 (39.1%); ECC: 973 (60.9%)]. Death/severe neurological injury occurred in 17.8% (N=111) and 21.7% (N=211) of twins who received DCC and ECC, respectively. The rate of death/severe neurological injury did not significantly differ between DCC and ECC groups (aOR 1.07, 95% CI 0.78-1.47). DCC was associated with reduced blood transfusions (adjusted β coefficient -0.49, 95% CI -0.86, -0.12) and NICU length of stay (adjusted β coefficient -4.17, 95% CI -8.15, -0.19). CONCLUSIONS: The primary composite outcome of death and/or severe neurological injury did not differ between twins born at <30 weeks of gestation who received DCC and ECC, but DCC was associated with some benefits.