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Delayed versus immediate cord clamping in preterm infants

Tarnow-Mordi, W.
; 
Morris, J.
; 
Kirby, Adrienne
; 
Robledo, Kristy
; 
Askie, Lisa
; 
Brown, Rebecca
; 
Evans, Nicholas
; 
Finlayson, Sarah
; 
Fogarty, Michael
; 
Gebski, Val
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Author
Tarnow-Mordi, W.
Morris, J.
Kirby, Adrienne
Robledo, Kristy
Askie, Lisa
Brown, Rebecca
Evans, Nicholas
Finlayson, Sarah
Fogarty, Michael
Gebski, Val
Ghadge, Alpana
Hague, Wendy
Isaacs, David
Jeffery, Michele
Keech, Anthony C.
Kluckow, Martin
Popat, Himanshu P.
Sebastian, Lucille
Aagaard, Kjersti M.
Belfort, Michael
Pammi, Mohan
Abdel-Latif, Mohamed
Reynolds, Graham
Ariff, Shabina
Sheikh, Lumaan
Chen, Yan
Colditz, Paul
Liley, Helen
Pritchard, Margo
de Luca, Daniele
de Waal, Koert
Forder, Peta
Biostat, M.
Duley, Lelia
El-Naggar, Walid
Gill, Andrew
Newnham, John
Simmer, Karen
Groom, Katie
Weston, Philip
Gullam, Joanna
Patel, Harshad
Koh, Guan
Lui, Kei
Marlow, Neil
Morris, Scott
Sehgal, Arvind
Wallace, Euan
Soll, Roger
Young, Leslie
Sweet, David
Walker, Susan
Watkins, Andrew
Wright, Ian
Osborn, David
Simes, John
Abstract
Background: The preferred timing of umbilical-cord clamping in preterm infants is unclear. Methods: We randomly assigned fetuses from women who were expected to deliver before 30 weeks of gestation to either immediate clamping of the umbilical cord (≤10 seconds after delivery) or delayed clamping (≥60 seconds after delivery). The primary composite outcome was death or major morbidity (defined as severe brain injury on postnatal ultrasonography, severe retinopathy of prematurity, necrotizing enterocolitis, or late-onset sepsis) by 36 weeks of postmenstrual age. Analyses were performed on an intention-to-treat basis, accounting for multiple births. Results: Of 1634 fetuses that underwent randomization, 1566 were born alive before 30 weeks of gestation; of these, 782 were assigned to immediate cord clamping and 784 to delayed cord clamping. The median time between delivery and cord clamping was 5 seconds and 60 seconds in the respective groups. Complete data on the primary outcome were available for 1497 infants (95.6%). There was no significant difference in the incidence of the primary outcome between infants assigned to delayed clamping (37.0%) and those assigned to immediate clamping (37.2%) (relative risk, 1.00; 95% confidence interval, 0.88 to 1.13; P=0.96). The mortality was 6.4% in the delayed-clamping group and 9.0% in the immediate-clamping group (P=0.03 in unadjusted analyses; P=0.39 after post hoc adjustment for multiple secondary outcomes). There were no significant differences between the two groups in the incidences of chronic lung disease or other major morbidities. Conclusions: Among preterm infants, delayed cord clamping did not result in a lower incidence of the combined outcome of death or major morbidity at 36 weeks of gestation than immediate cord clamping. (Funded by the Australian National Health and Medical Research Council [NHMRC] and the NHMRC Clinical Trials Centre; APTS Australian and New Zealand Clinical Trials Registry number, ACTRN12610000633088. opens in new tab.)
Keywords
Date
2017
Type
Journal article
Journal
New England Journal of Medicine
Book
Volume
377
Issue
5
Page Range
2445-2455
Article Number
ACU Department
Faculty of Education and Arts
Collections
Faculty of Education and Arts - General
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URI
https://hdl.handle.net/20.500.14802/17919
Relation URI
DOI
10.1056/NEJMoa1711281
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