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Delayed versus Immediate Cord Clamping in Preterm Infants.

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  • 1. From the National Health and Medical Research Council Clinical Trials Centre, University of Sydney (W.T.-M., A. Kirby, K.R., L.A., R.B., S.F., V.G., A. Ghadge, W.H., A. Keech, L. Sebastian, J.S.), University of Sydney (J.M., N.E., M.F., D.I., M.J., M.K., H. Popat, H.L., D.O.), Royal North Shore Hospital (Y.C.), and University of New South Wales (K.L.), Sydney, Australian National University, Canberra (M.A.-L., G.R.), University of Queensland, Brisbane (P.C., H.L., M. Pritchard), James Cook University, Cairns (G.K.), University of Western Australia, Perth (A. Gill, J.N., K.S.), Flinders University, Adelaide (S.M.), Monash University (A.S., E.W.) and University of Melbourne (S.W.), Melbourne, Mercy Hospital for Women, Heidelberg (A.W.), and University of Newcastle, Newcastle (K.W., P.F.), and University of Wollongong, Wollongong (I.W.) - all in Australia; Baylor College of Medicine, Houston (K.A., M.B., M. Pammi); Aga Khan University Hospital, Karachi, Pakistan (S.A., L. Sheikh); Hôpital Antoine-Beclere, Clamart, France (D.L.); University of Nottingham, Nottingham, United Kingdom (L.D.); Dalhousie University, Halifax, NS, Canada (W.E.-N.); University of Auckland, Auckland (K.G.), and University of Otago, Dunedin (P.W., J.G., H. Patel) - both in New Zealand; University College London, London (N.M.), and Royal Jubilee Maternity Hospital, Belfast (D.S.) - both in the United Kingdom; and University of Vermont, Burlington (R.S., L.Y.).
      Authors
    • Tarnow-Mordi W 1
    • Morris J 1
    • Kirby A 1
    • Robledo K 1
    • Askie L 1
    • Brown R 1
    • Evans N 1
    • Finlayson S 1
    • Fogarty M 1
    • Gebski V 1
    • Ghadge A 1
    • Hague W 1
    • Isaacs D 1
    • Jeffery M 1
    • Keech A 1
    • Kluckow M 1
    • Popat H 1
    • Sebastian L 1
    • Aagaard K 1
    • Belfort M 1
    • Pammi M 1
    • Abdel-Latif M 1
    • Reynolds G 1
    • Ariff S 1
    • Sheikh L 1
    • Chen Y 1
    • Colditz P 1
    • Liley H 1
    • Pritchard M 1
    • de Luca D 1
    • de Waal K 1
    • Forder P 1
    • Duley L 1
    • El-Naggar W 1
    • Gill A 1
    • Newnham J 1
    • Simmer K 1
    • Groom K 1
    • Weston P 1
    • Gullam J 1
    • Patel H 1
    • Koh G 1
    • Lui K 1
    • Marlow N 1
    • Morris S 1
    • Sehgal A 1
    • Wallace E 1
    • Soll R 1
    • Young L 1
    • Sweet D 1
    • Walker S 1
    • Watkins A 1
    • Wright I 1
    • Osborn D 1
    • Simes J 1
    (55 authors)

ORCIDs linked to this article

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The New England Journal of Medicine, 29 Oct 2017, 377(25):2445-2455
https://doi.org/10.1056/nejmoa1711281 PMID: 29081267 

A comment on this article appears in "Delayed cord clamping in preterm infants: is it time to become standard practice?" J Perinatol. 2019 Mar;39(3):513-515. A comment on this article appears in "Delayed cord clamping may not be beneficial in the premature infant." J Pediatr. 2018 May;196:324-327. A comment on this article appears in "The Timing of Cord Clamping for Preterm Infants." N Engl J Med. 2017 Dec 21;377(25):2488-2489.

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 .).

Full text links 

Read article at publisher's site: https://doi.org/10.1056/nejmoa1711281

Read article for free, from open access legal sources, via Unpaywall: https://www.nejm.org/doi/pdf/10.1056/NEJMoa1711281?articleTools=trueUnpaywall

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Funding 

Funders who supported this work.

Medical Research Council (1)

National Institute for Health Research (NIHR) (2)