Timing of Umbilical Cord Clamping Among Infants Born at 22 Through 27 Weeks' Gestation

Overview

Journal J Perinatol

Specialty Gynecology & Obstetrics

Date 2015 Sep 25

PMID 26401752

Citations 22

Authors

C H Backes

H Huang

J D Iams

J A Bauer

P J Giannone

Affiliations

Soon will be listed here.

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.

Citing Articles

The effect of delayed cord clamping on early cardiac and cerebral hemodynamics, mortality, and severe intraventricular hemorrhage in preterm infants < 32 weeks: a systematic review and meta-analysis of clinical trials.

Aljohani E, Goyal M Eur J Pediatr. 2025; 184(3):210.

PMID: 40009183 DOI: 10.1007/s00431-025-06026-7.

A survey on management practices of hypotension in preterm neonates: an Indian perspective.

Das R, Nagpal R, Deshpande S, Kumar G, Singh A, Kallimath A Front Pediatr. 2024; 12:1411719.

PMID: 39497735 PMC: 11532123. DOI: 10.3389/fped.2024.1411719.

Umbilical cord milking and delayed cord clamping for the prevention of neonatal hypoglycaemia: a systematic review and meta-analysis.

Watson E, Roberts L, Harding J, Crowther C, Lin L BMC Pregnancy Childbirth. 2024; 24(1):248.

PMID: 38589786 PMC: 11000397. DOI: 10.1186/s12884-024-06427-w.

[Interpretation of 2023 American Heart Association and American Academy of Pediatrics focused update on neonatal resuscitation guidelines].

Zhu T, Shi Y Zhongguo Dang Dai Er Ke Za Zhi. 2024; 26(1):25-30.

PMID: 38269455 PMC: 10817739. DOI: 10.7499/j.issn.1008-8830.2311107.

Interventions to Reduce Severe Brain Injury Risk in Preterm Neonates: A Systematic Review and Meta-analysis.

Razak A, Patel W, Durrani N, Pullattayil A JAMA Netw Open. 2023; 6(4):e237473.

PMID: 37052920 PMC: 10102877. DOI: 10.1001/jamanetworkopen.2023.7473.

References

Hosono S, Mugishima H, Fujita H, Hosono A, Minato M, Okada T . Umbilical cord milking reduces the need for red cell transfusions and improves neonatal adaptation in infants born at less than 29 weeks' gestation: a randomised controlled trial. Arch Dis Child Fetal Neonatal Ed. 2007; 93(1):F14-9. DOI: 10.1136/adc.2006.108902. View

Papile L, BURSTEIN J, Burstein R, KOFFLER H . Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr. 1978; 92(4):529-34. DOI: 10.1016/s0022-3476(78)80282-0. View

Mercer J, McGrath M, Hensman A, Silver H, Oh W . Immediate and delayed cord clamping in infants born between 24 and 32 weeks: a pilot randomized controlled trial. J Perinatol. 2003; 23(6):466-72. DOI: 10.1038/sj.jp.7210970. View

Watkins A, West C, Cooke R . Blood pressure and cerebral haemorrhage and ischaemia in very low birthweight infants. Early Hum Dev. 1989; 19(2):103-10. DOI: 10.1016/0378-3782(89)90120-5. View

. Committee Opinion No.543: Timing of umbilical cord clamping after birth. Obstet Gynecol. 2012; 120(6):1522-6. DOI: 10.1097/01.AOG.0000423817.47165.48. View

Hutchon D, Thakur I . Resuscitate with the placental circulation intact. Arch Dis Child. 2008; 93(5):451. View

Rabe H, Reynolds G, Diaz-Rossello J . A systematic review and meta-analysis of a brief delay in clamping the umbilical cord of preterm infants. Neonatology. 2007; 93(2):138-44. DOI: 10.1159/000108764. View

Bell M, TERNBERG J, Feigin R, Keating J, Marshall R, Barton L . Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg. 1978; 187(1):1-7. PMC: 1396409. DOI: 10.1097/00000658-197801000-00001. View

Rabe H, Reynolds G, Diaz-Rossello J . Early versus delayed umbilical cord clamping in preterm infants. Cochrane Database Syst Rev. 2004; (4):CD003248. DOI: 10.1002/14651858.CD003248.pub2. View

10.

McCall E, Alderdice F, Halliday H, JENKINS J, Vohra S . Interventions to prevent hypothermia at birth in preterm and/or low birthweight infants. Cochrane Database Syst Rev. 2008; (1):CD004210. DOI: 10.1002/14651858.CD004210.pub3. View

10.

Raju T, Mercer B, Burchfield D, Joseph Jr G . Periviable birth: executive summary of a joint workshop by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, American Academy of Pediatrics, and American College of.... Obstet Gynecol. 2014; 123(5):1083-1096. DOI: 10.1097/AOG.0000000000000243. View

11.

PRENDIVILLE W, Elbourne D, McDonald S . Active versus expectant management in the third stage of labour. Cochrane Database Syst Rev. 2000; (2):CD000007. DOI: 10.1002/14651858.CD000007. View

12.

DeMauro S, Douglas E, Karp K, Schmidt B, Patel J, Kronberger A . Improving delivery room management for very preterm infants. Pediatrics. 2013; 132(4):e1018-25. DOI: 10.1542/peds.2013-0686. View

13.

Rabe H, Diaz-Rossello J, Duley L, Dowswell T . Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes. Cochrane Database Syst Rev. 2012; (8):CD003248. DOI: 10.1002/14651858.CD003248.pub3. View

14.

Ersdal H, Linde J, Mduma E, Auestad B, Perlman J . Neonatal outcome following cord clamping after onset of spontaneous respiration. Pediatrics. 2014; 134(2):265-72. DOI: 10.1542/peds.2014-0467. View

15.

Tarnow-Mordi W, Duley L, Field D, Marlow N, Morris J, Newnham J . Timing of cord clamping in very preterm infants: more evidence is needed. Am J Obstet Gynecol. 2014; 211(2):118-23. DOI: 10.1016/j.ajog.2014.03.055. View

16.

Strauss R, Mock D, Johnson K, Cress G, Burmeister L, Zimmerman M . A randomized clinical trial comparing immediate versus delayed clamping of the umbilical cord in preterm infants: short-term clinical and laboratory endpoints. Transfusion. 2008; 48(4):658-65. PMC: 2883857. DOI: 10.1111/j.1537-2995.2007.01589.x. View

17.

Aladangady N, McHugh S, Aitchison T, Wardrop C, Holland B . Infants' blood volume in a controlled trial of placental transfusion at preterm delivery. Pediatrics. 2006; 117(1):93-8. DOI: 10.1542/peds.2004-1773. View

18.

Baenziger O, Stolkin F, Keel M, von Siebenthal K, Fauchere J, Das Kundu S . The influence of the timing of cord clamping on postnatal cerebral oxygenation in preterm neonates: a randomized, controlled trial. Pediatrics. 2007; 119(3):455-9. DOI: 10.1542/peds.2006-2725. View

19.

Mercer J, Vohr B, McGrath M, Padbury J, Wallach M, Oh W . Delayed cord clamping in very preterm infants reduces the incidence of intraventricular hemorrhage and late-onset sepsis: a randomized, controlled trial. Pediatrics. 2006; 117(4):1235-42. PMC: 1564438. DOI: 10.1542/peds.2005-1706. View