Delayed versus Immediate Cord Clamping in Preterm Infants

William Tarnow‐Mordi(National Health and Medical Research Council), Jonathan Morris(National Health and Medical Research Council), Adrienne Kirby(National Health and Medical Research Council), Kristy Robledo(University Hospital Heidelberg), Lisa Askie(Heidelberg University), Rebecca T. Brown(National Health and Medical Research Council), Nicholas Evans(The University of Sydney), Sarah Finlayson(Heidelberg University), Michael J. Fogarty(University Hospital Heidelberg), Val Gebski(University Hospital Heidelberg), Alpana Ghadge(Heidelberg University), Wendy Hague(Heidelberg University), David Isaacs(National Health and Medical Research Council), Michelle Jeffery(University Hospital Heidelberg), Anthony Keech(National Health and Medical Research Council), Martin Kluckow(National Health and Medical Research Council), Himanshu Popat(National Health and Medical Research Council), Lucille Sebastian(University Hospital Heidelberg), Kjersti M. Aagaard(Heidelberg University), Michael A. Belfort(Baylor College of Medicine), Mohan Pammi(National Health and Medical Research Council), Mohamed Abdellatif(University Hospital Heidelberg), Graham Reynolds(Heidelberg University), Shabina Ariff(National Health and Medical Research Council), Lumaan Sheikh(National Health and Medical Research Council), Yan Chen(National Health and Medical Research Council), Paul B. Colditz(University Hospital Heidelberg), Helen G. Liley(Heidelberg University), M. A. Pritchard(The University of Queensland), Danièle De Luca(National Health and Medical Research Council), Koert de Waal(University Hospital Heidelberg), Peta Forder(National Health and Medical Research Council), Lelia Duley(University Hospital Heidelberg), Walid El‐Naggar(University Hospital Heidelberg), Andrew Gill(Heidelberg University), John P. Newnham(University Hospital Heidelberg), Karen Simmer(The University of Western Australia), Katie Groom(National Health and Medical Research Council), Philip J. Weston(National Health and Medical Research Council), Joanna Gullam(Heidelberg University), Harshad Patel(National Health and Medical Research Council), Guan Koh(National Health and Medical Research Council), Kei Lui(UNSW Sydney), Neil Marlow(Heidelberg University), Scott A. Morris(Heidelberg University), Arvind Sehgal(Australian Regenerative Medicine Institute), Euan M. Wallace(National Health and Medical Research Council), Roger F. Soll(National Health and Medical Research Council), Leslie Young(Heidelberg University), David G. Sweet(National Health and Medical Research Council), Susan Walker(University Hospital Heidelberg), Andrew M. Watkins(Heidelberg University), Ian Wright(Heidelberg University), David A Osborn(Heidelberg University), John Simes(National Health and Medical Research Council)
New England Journal of Medicine
October 29, 2017
10.1056/nejmoa1711281
Cited by 304Open Access
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Abstract

BACKGROUND: The preferred timing of umbilical-cord clamping in preterm infants is unclear. METHODS: We randomly assigned fetuses from women who were expected to deliver before 30 weeks of gestation to either immediate clamping of the umbilical cord (≤10 seconds after delivery) or delayed clamping (≥60 seconds after delivery). The primary composite outcome was death or major morbidity (defined as severe brain injury on postnatal ultrasonography, severe retinopathy of prematurity, necrotizing enterocolitis, or late-onset sepsis) by 36 weeks of postmenstrual age. Analyses were performed on an intention-to-treat basis, accounting for multiple births. RESULTS: Of 1634 fetuses that underwent randomization, 1566 were born alive before 30 weeks of gestation; of these, 782 were assigned to immediate cord clamping and 784 to delayed cord clamping. The median time between delivery and cord clamping was 5 seconds and 60 seconds in the respective groups. Complete data on the primary outcome were available for 1497 infants (95.6%). There was no significant difference in the incidence of the primary outcome between infants assigned to delayed clamping (37.0%) and those assigned to immediate clamping (37.2%) (relative risk, 1.00; 95% confidence interval, 0.88 to 1.13; P=0.96). The mortality was 6.4% in the delayed-clamping group and 9.0% in the immediate-clamping group (P=0.03 in unadjusted analyses; P=0.39 after post hoc adjustment for multiple secondary outcomes). There were no significant differences between the two groups in the incidences of chronic lung disease or other major morbidities. CONCLUSIONS: Among preterm infants, delayed cord clamping did not result in a lower incidence of the combined outcome of death or major morbidity at 36 weeks of gestation than immediate cord clamping. (Funded by the Australian National Health and Medical Research Council [NHMRC] and the NHMRC Clinical Trials Centre; APTS Australian and New Zealand Clinical Trials Registry number, ACTRN12610000633088 .).

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