Delayed Cord Clamping 3

Immediate and delayed cord clamping in infants born between 24 and 32 weeks: a pilot randomized controlled trial. Mercer JS, McGrath MM, Hensman A, et al. J Perinatol (Sep 2003); 23:466-72.

Objective: This pilot study's aim was to establish feasibility of a protocol for delayed cord clamping (DCC) versus immediate cord clamping (ICC) at preterm birth and to examine its effects on initial blood pressure and other outcomes.

Study Design: A randomized controlled trial recruited 32 infants between 24 and 32 weeks. Immediately before delivery, mothers were randomized to ICC (cord clamped at 5 to 10 seconds) or DCC (30- to 45-second delay in cord clamping) groups.

Results: Intention-to-treat analyses revealed that the DCC group were more likely to have higher initial mean blood pressures (adjusted OR 3.4) and less likely to be discharged on oxygen (adjusted OR 8.6). DCC group infants had higher initial glucose levels (ICC=36 mg/dl, DCC=73.1 mg/dl; p=0.02)

Conclusion: The research design is feasible. The immediate benefit of improved blood pressure was confirmed and other findings deserve consideration for further study.

Comment. This provides further evidence that delayed cord clamping is beneficial, especially in preterm infants. Previous studies have shown that this practice results in less need for volume resuscitation for hypotension, and fewer blood transfusions (see 1-024 and 3-019). We can now add to the list of potential benefits: less initial hypoglycemia, less severe chronic lung disease, less suspected NEC. This is a simple, no-cost intervention that poses minimal risk as long as the placental circulation in intact. The present study suffers from small sample size, and we badly need a large RCT to confirm these findings. In the meantime, I would suggest that we have very little data to support the efficacy of immediate cord clamping. ABK.

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