Delayed versus Immediate Cord Clamping in Preterm Infants.
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Tarnow-Mordi William, Morris Jonathan, Kirby Adrienne, Robledo Kristy, Askie Lisa, Brown Rebecca, Evans Nicholas, Finlayson Sarah, Fogarty Michael, Gebski Val, Ghadge Alpana, Hague Wendy, Isaacs David, Jeffery Michelle, Keech Anthony, Kluckow Martin, Popat Himanshu, Sebastian Lucille, Aagaard Kjersti, Belfort Michael, Pammi Mohan, Abdel-Latif Mohamed, Reynolds Graham, Ariff Shabina, Sheikh Lumaan, Chen Yan, Colditz Paul, Liley Helen, Pritchard Margo, de Luca Daniele, de Waal Koert, Forder Peta, Duley Lelia, El-Naggar Walid, Gill Andrew, Newnham John, Simmer Karen, Groom Katie, Weston Philip, Gullam Joanna, Patel Harshad, Koh Guan, Lui Kei, Marlow Neil, Morris Scott, Sehgal Arvind, Wallace Euan, Soll Roger, Young Leslie, Sweet David, Walker Susan, Watkins Andrew, Wright Ian, Osborn David, Simes John, Australian Placental Transfusion Study Collaborative Group
Аннотация
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 .).