Hemodynamic effect of delayed cord clamping versus early cord clamping in preterm twins using echocardiography: a prospective observational study.

BACKGROUND

To compare echocardiographic metrics in preterm twins who underwent delayed cord clamping (DCC) versus early cord clamping (ECC).

METHODS

Prospective observational cohort study conducted at CHU Sainte Justine in Montreal involving preterm neonates between 24 and 36 weeks of gestational age. Neonates with congenital malformations, twin-to-twin transfusion syndrome, and the need of ECC for resuscitation were excluded. Echocardiography assessed the systemic blood flow.

RESULTS

63 twins were included: 47 neonates receiving DCC, and 16 undergoing ECC. Superior vena cava (SVC) blood flow was comparable between the DCC and ECC groups at 6-9 h (78 ± 26.9 vs. 62 ± 20.1 mL/kg/min; p = 0.08) and 24-48 h (106 ± 31.2 vs. 87 ± 23.1 mL/kg/min; p = 0.07). Left ventricular output (LVO) was higher in the ECC group at 24-48 h (153 ± 30 vs. 187 ± 66 mL/kg/min; p = 0.01). TAPSE Z-score was higher in the DCC group at 24-48 h (-0.1 ± 1.9 vs. -1.1 ± 2.2 cm, p = 0.04). Systolic velocity of the right ventricle lateral wall was higher in the DCC group.

CONCLUSION

In preterm twins, DCC was associated with improved echocardiographic indicators of cardiovascular stability and improved right ventricular function suggesting a potential benefit of DCC in this population.

IMPACT: This prospective study implies a potential benefit of delayed cord clamping in a population of preterm twins and suggests to perform delayed cord clamping in this population.