Abstract
Purpose: Preterm infants, many with respiratory disease, need RBC transfusions early in life. Although studies in preterm infants of immediate versus delayed cord clamping suggested improved hemodynamics and fewer transfusions after delayed clamping, results are inconsistent. Previously, we reported (Transfusion 2003;43:1168) increased intravascular RBC volume/mass (measured with biotin-labeled RBCs) following delayed cord clamping. Now, we report whether this increased RBC volume/mass alters RBC transfusions.
Methods: A prospective, randomized trial tested the hypothesis that delayed cord clamping would expand neonatal RBC volume/mass sufficiently to reduce transfusions. Following consent, preterm infants (<36 weeks gestation) were randomized to immediate (<5 seconds) or delayed (60 seconds) cord clamping. Infants too unstable for delayed clamping experienced immediate clamping followed by transfusion of autologous/placental RBCs to simulate delayed clamping. Later transfusions (15 mL/kg) for all infants were prescribed using uniform guidelines.
Results: Results are reported as mean values for immediate versus delayed clamping. Biotin RBC volume/mass within 24 hours of birth = 36.8 vs 42.1 mL/kg (p = 0.04). Concurrent hematocrit = 53.6 vs 54.0% (p = 0.86). 71% (59 of 83 infants) with immediate clamping versus 83% (44 of 53 infants) with delayed clamping needed no transfusions (p = 0.20). Thus, 24 infants with immediate clamping received 107 transfusions (4.5/infant) versus 9 infants with delayed clamping given 36 transfusions (4.0/infant) (p = 0.37).
Conclusions: Intravascular RBC volume/mass significantly increases with delayed cord clamping; not reflected by different hematocrits. This increased RBC volume/mass was not sufficient to significantly reduce RBC transfusions. However, a trend was evident, suggesting additional studies are warranted.
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Strauss, R., Mock, D., Johnson, K. et al. 361 Prospective, Randomized Trial of Immediate Vs Delayed Cord Clamping in Preterm Infants: Effects on Intravascular RBC Volume/Mass and RBC Transfusions. Pediatr Res 58, 416 (2005). https://doi.org/10.1203/00006450-200508000-00390
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DOI: https://doi.org/10.1203/00006450-200508000-00390