Immediate versus Delayed Umbilical Cord Clamping in Premature Neonates Born < 35 Weeks: A Prospective, Randomized, Controlled Study

TLDR

The study aimed to determine whether delayed cord clamping improves blood pressure, hematocrit, and clinical outcomes compared with immediate clamping in infants born before 35 weeks. A prospective, masked, randomized controlled trial assigned 35 infants to immediate clamping (5–10 s) and 30 infants to delayed clamping (30–45 s). Delayed clamping was associated with higher initial diastolic blood pressure and hematocrit, especially in vaginal deliveries, and in infants under 1500 g it led to higher mean blood pressure and reduced need for mechanical ventilation and surfactant, without increasing polycythemia but showing a trend toward higher bilirubin; overall the benefits were modest and warrant larger studies.

Abstract

The purpose of this study was to test whether delayed versus immediate cord clamping would result in higher blood pressure (BP) and hematocrit (Hct), and to assess its clinical effects on the neonatal course in premature neonates (< 35 weeks). This was a prospective, masked, randomized, controlled study. Prior to delivery, 35 neonates were randomly assigned to immediate cord clamping (ICC) at 5 to 10 seconds, and a comparable group of 30 neonates were randomly assigned to delayed cord clamping (DCC) at 30 to 45 seconds. Intention-to-treat analyses revealed that the DCC group tended to have higher initial diastolic BP and higher Hct (especially in vaginally delivered neonates). Infants weighing < 1500 g with DCC tended to have higher mean BP, and needed less mechanical ventilation and surfactant compared with ICC neonates. Infants with DCC did not experience more polycythemia (Hct > 60%), but had a trend toward higher bilirubin levels with no differences in the phototherapy needs. DCC seems to be safe and may be beneficial when compared with ICC in premature neonates. However, the differences between the two methods were modest and the clinical relevance needs to be assessed further by larger studies and additional meta-analysis of randomized trials.