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Timing of umbilical cord clamping among infants born at 22 through 27 weeks’ gestation

Journal of Perinatology volume 36, pages 35–40 (2016)Cite this article

Subjects

Abstract

Objective:

To investigate the safety, feasibility and efficacy of delayed cord clamping (DCC) compared with immediate cord clamping (ICC) at delivery among infants born at 22 to 27 weeks’ gestation.

Study Design:

This was a pilot, randomized, controlled trial in which women in labor with singleton pregnancies at 22 to 27 weeks’ gestation were randomly assigned to ICC (cord clamped at 5 to 10 s) or DCC (30 to 45 s).

Results:

Forty mother–infant pairs were randomized. Infants in the ICC and DCC groups had mean gestational ages (GA) of 24.6 and 24.4 weeks, respectively. No differences were observed between the groups across all available safety measures, although infants in the DCC group had higher admission temperatures than infants in the ICC group (97.4 vs 96.2 °F, P=0.04). During the first 24 h of life, blood pressures were lower in the ICC group than in the DCC group (P<0.05), despite a threefold greater incidence of treatment for hypotension (45% vs 12%, P<0.01). Infants in the ICC group had increased numbers of red blood transfusions (in first 28 days of life) than infants in DCC group (4.1±3.9 vs 2.8±2.2, P=0.04).

Conclusion:

Among infants born at an average GA of 24 weeks’, DCC appears safe, logistically feasible, and offers hematological and circulatory advantages compared with ICC. A more comprehensive appraisal of this practice is needed.

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Acknowledgements

The present work is supported in part by a grant from the American Heart Association (# 10CRP3730033, CHB) and by internal funding provided by Nationwide Children’s Hospital Research Institute. We wish to thank Jessica Deverse, BA, and all the nurses in the neonatal intensive care unit at The Ohio State University Wexner Medical Center for their efforts in patient recruitment.

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Authors and Affiliations

  1. The Center for Perinatal Research, Nationwide Children’s Hospital, Columbus, OH, USA

    C H Backes

  2. The Heart Center, Nationwide Children’s Hospital, Columbus, OH, USA

    C H Backes

  3. Department of Pediatrics, The Center for Perinatal Research and The Heart Center, Nationwide Children’s Hospital, Columbus, OH, USA

    C H Backes

  4. Department of Obstetrics/Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    C H Backes & J D Iams

  5. Department of Pediatrics, University of Kentucky, Lexington, KY, USA

    H Huang, J A Bauer & P J Giannone

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  1. C H Backes
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Correspondence to C H Backes.

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Supplementary Information accompanies the paper on the Journal of Perinatology website

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Backes, C., Huang, H., Iams, J. et al. Timing of umbilical cord clamping among infants born at 22 through 27 weeks’ gestation. J Perinatol 36, 35–40 (2016). https://doi.org/10.1038/jp.2015.117

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