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Delayed versus Immediate Cord Clamping in Preterm Infants

Tarnow-Mordi, W; Morris, J; Kirby, A; Robledo, K; Askie, L; Brown, R; Evans, N; ... Simes, J; + view all (2017) Delayed versus Immediate Cord Clamping in Preterm Infants. New England Journal of Medicine , 377 (25) pp. 2445-2455. 10.1056/NEJMoa1711281.

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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.

Type: Article
Title: Delayed versus Immediate Cord Clamping in Preterm Infants
DOI: 10.1056/NEJMoa1711281
Publisher version: http://doi.org/10.1056/NEJMoa1711281
Language: English
Additional information: Copyright © 2017 Massachusetts Medical Society. All rights reserved. This version is the version of record. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Science & Technology, Life Sciences & Biomedicine, Medicine, General & Internal, General & Internal Medicine, HEMATOPOIETIC-CELL TRANSPLANTATION, PREVENT CYTOMEGALOVIRUS DISEASE, ANTICYTOMEGALOVIRUS COMPOUND AIC246, IN-VITRO, MARROW-TRANSPLANTATION, DOUBLE-BLIND, GANCICLOVIR PROPHYLAXIS, MARIBAVIR PROPHYLAXIS, LETERMOVIR RESISTANCE, PREEMPTIVE TREATMENT
URI: http://discovery.ucl.ac.uk/id/eprint/10043266
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