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A comparison of strategies for managing the umbilical cord at birth in preterm infants

A comparison of strategies for managing the umbilical cord at birth in preterm infants
A comparison of strategies for managing the umbilical cord at birth in preterm infants

Objective: to evaluate the rates of practice, and the associations between different cord management strategies at birth (delayed cord clamping [DCC], umbilical cord milking [UCM], and early cord clamping [ECC]) and mortality or major morbidity, rates of blood transfusion, and peak serum bilirubin in a large national cohort of very preterm infants. 

Study design: we retrospectively studied preterm infants <33 weeks of gestation admitted to the Canadian Neonatal Network between January 2015 and December 2017. Patients who received ECC (<30 seconds), UCM, or DCC (≥30 seconds) were compared. Multiple generalized linear/quantile logistic regression models were used. 

Results: of 12 749 admitted infants, 9729 were included; 4916 (50.5%) received ECC, 394 (4.1%) UCM, and 4419 (45.4%) DCC. After adjustment for potential confounders identified between groups in univariate analyses, the odds of mortality or major morbidity were higher in the ECC group when compared with UCM group (aOR, 1.18; 95% CI, 1.03-1.35). Mortality and intraventricular hemorrhage were associated with ECC as compared with DCC (aOR, 1.6 [95% CI, 1.22-2.1] and aOR, 1.29 [95% CI, 1.19-1.41], respectively). The odds of severe intraventricular hemorrhage were higher with UCM compared with DCC (aOR, 1.38; 95% CI, 1.05-1.81). Rates of blood transfusion were higher with ECC compared with UCM and DCC (aOR, 1.67 [95% CI, 1.31-2.14] and aOR, 1.68 [95% CI, 1.35-2.09], respectively), although peak serum bilirubin levels were not significantly different. 

Conclusions: both DCC and UCM were associated with better short-term outcomes than ECC; however, the odds of severe intraventricular hemorrhage were higher with UCM compared with DCC.

blood transfusion, delayed cord clamping, early cord clamping, intraventricular hemorrhage, major morbidity, mortality, peak serum bilirubin, short-term outcomes, umbilical cord milking
0022-3476
58-64.e4
El-Naggar, Walid
c77c2888-8794-4cf4-8546-babee5668f74
Afifi, Jehier
5806e139-a9b0-4322-a5b0-545aa0f7d9c6
Dorling, Jon
e55dcb9a-a798-41a1-8753-9e9ff8aab630
Bodani, Jaya
58226e42-fdbd-4b95-8b9f-80ad0c28c79e
Cieslak, Zenon
445b3bea-d5a2-4885-841b-297fa0ba2f07
Canning, Rody
2d775fa2-9923-4c2c-bbe6-192d5e02abb2
Ye, Xiang Y.
ce3df069-de11-4a6c-8b7e-0656f5299aad
Crane, Joan
5610c6fc-6b4d-4caf-98af-9916f94541a7
Lee, Shoo K.
b4771f85-6bc5-4eef-aad3-a4e1d5323fdb
Shah, Prakesh S.
24a5b028-7ff0-4edd-b01a-1753262d68c9
Canadian Neonatal Network and the Canadian Preterm Birth Network Investigators
El-Naggar, Walid
c77c2888-8794-4cf4-8546-babee5668f74
Afifi, Jehier
5806e139-a9b0-4322-a5b0-545aa0f7d9c6
Dorling, Jon
e55dcb9a-a798-41a1-8753-9e9ff8aab630
Bodani, Jaya
58226e42-fdbd-4b95-8b9f-80ad0c28c79e
Cieslak, Zenon
445b3bea-d5a2-4885-841b-297fa0ba2f07
Canning, Rody
2d775fa2-9923-4c2c-bbe6-192d5e02abb2
Ye, Xiang Y.
ce3df069-de11-4a6c-8b7e-0656f5299aad
Crane, Joan
5610c6fc-6b4d-4caf-98af-9916f94541a7
Lee, Shoo K.
b4771f85-6bc5-4eef-aad3-a4e1d5323fdb
Shah, Prakesh S.
24a5b028-7ff0-4edd-b01a-1753262d68c9

Canadian Neonatal Network and the Canadian Preterm Birth Network Investigators (2020) A comparison of strategies for managing the umbilical cord at birth in preterm infants. Journal of Pediatrics, 225, 58-64.e4. (doi:10.1016/j.jpeds.2020.05.018).

Record type: Article

Abstract

Objective: to evaluate the rates of practice, and the associations between different cord management strategies at birth (delayed cord clamping [DCC], umbilical cord milking [UCM], and early cord clamping [ECC]) and mortality or major morbidity, rates of blood transfusion, and peak serum bilirubin in a large national cohort of very preterm infants. 

Study design: we retrospectively studied preterm infants <33 weeks of gestation admitted to the Canadian Neonatal Network between January 2015 and December 2017. Patients who received ECC (<30 seconds), UCM, or DCC (≥30 seconds) were compared. Multiple generalized linear/quantile logistic regression models were used. 

Results: of 12 749 admitted infants, 9729 were included; 4916 (50.5%) received ECC, 394 (4.1%) UCM, and 4419 (45.4%) DCC. After adjustment for potential confounders identified between groups in univariate analyses, the odds of mortality or major morbidity were higher in the ECC group when compared with UCM group (aOR, 1.18; 95% CI, 1.03-1.35). Mortality and intraventricular hemorrhage were associated with ECC as compared with DCC (aOR, 1.6 [95% CI, 1.22-2.1] and aOR, 1.29 [95% CI, 1.19-1.41], respectively). The odds of severe intraventricular hemorrhage were higher with UCM compared with DCC (aOR, 1.38; 95% CI, 1.05-1.81). Rates of blood transfusion were higher with ECC compared with UCM and DCC (aOR, 1.67 [95% CI, 1.31-2.14] and aOR, 1.68 [95% CI, 1.35-2.09], respectively), although peak serum bilirubin levels were not significantly different. 

Conclusions: both DCC and UCM were associated with better short-term outcomes than ECC; however, the odds of severe intraventricular hemorrhage were higher with UCM compared with DCC.

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More information

Accepted/In Press date: 13 May 2020
e-pub ahead of print date: 20 May 2020
Published date: 22 September 2020
Additional Information: Funding Information: Organizational support for the Canadian Neonatal Network and the Canadian Preterm Birth Network was provided by the Maternal-infant Care Research Centre (MiCare) at Mount Sinai Hospital in Toronto, Ontario, Canada. MiCare is supported by a Canadian Institutes of Health Research (CIHR) Team Grant ( CTP 87518 ), the Ontario Ministry of Health and Long-Term Care , and the participating hospitals. PSS holds a CIHR Applied Research Chair in Reproductive and Child Health Services and Policy Research (APR-126340). The funders had no roles in the study design; the collection, analysis, or interpretation of data; the writing of the report; or the decision to submit the article for publication. We confirm the independence of the study researchers from the funders; and we confirm that all authors, external and internal, had full access to all the data in the study and can take responsibility for the integrity of the data and the accuracy of the analysis. The authors declare no conflicts of interest. We thank all site investigators and data abstractors of the Canadian Neonatal Network (CNN) and the Canadian Preterm Birth Network (CPTBN). We thank Heather McDonald Kinkaid, PhD, from the Maternal-infant Care Research Centre (MiCare) at Mount Sinai Hospital in Toronto, Ontario, for editorial support in the preparation of this manuscript; and other MiCare staff for organizational support of CNN and CPTBN. MiCare is supported by funding from the Canadian Institutes of Health Research, the Ontario Ministry of Health and Long-Term Care, and the participating hospitals.Organizational support for the Canadian Neonatal Network and the Canadian Preterm Birth Network was provided by the Maternal-infant Care Research Centre (MiCare) at Mount Sinai Hospital in Toronto, Ontario, Canada. MiCare is supported by a Canadian Institutes of Health Research (CIHR) Team Grant (CTP 87518), the Ontario Ministry of Health and Long-Term Care, and the participating hospitals. PSS holds a CIHR Applied Research Chair in Reproductive and Child Health Services and Policy Research (APR-126340). The funders had no roles in the study design; the collection, analysis, or interpretation of data; the writing of the report; or the decision to submit the article for publication. We confirm the independence of the study researchers from the funders; and we confirm that all authors, external and internal, had full access to all the data in the study and can take responsibility for the integrity of the data and the accuracy of the analysis. The authors declare no conflicts of interest. Funding and disclosure information is available at www.jpeds.com.
Keywords: blood transfusion, delayed cord clamping, early cord clamping, intraventricular hemorrhage, major morbidity, mortality, peak serum bilirubin, short-term outcomes, umbilical cord milking

Identifiers

Local EPrints ID: 485094
URI: http://eprints.soton.ac.uk/id/eprint/485094
ISSN: 0022-3476
PURE UUID: ccf5830e-6146-4f8f-8624-b0f92572c5eb
ORCID for Jon Dorling: ORCID iD orcid.org/0000-0002-1691-3221

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Date deposited: 29 Nov 2023 17:37
Last modified: 18 Mar 2024 04:16

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Contributors

Author: Walid El-Naggar
Author: Jehier Afifi
Author: Jon Dorling ORCID iD
Author: Jaya Bodani
Author: Zenon Cieslak
Author: Rody Canning
Author: Xiang Y. Ye
Author: Joan Crane
Author: Shoo K. Lee
Author: Prakesh S. Shah
Corporate Author: Canadian Neonatal Network and the Canadian Preterm Birth Network Investigators

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