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Early versus delayed umbilical cord clamping in infants with congenital heart disease: a pilot, randomized,
C H Backes1,2,3,4, H Huang1,3, C L Cua2,3
1Center for Perinatal Research, Nationwide Children's Hospital, Columbus, OH, USA.
Insights
Delayed umbilical cord clamping (DCC) is safe and feasible for neonates with congenital heart disease (CHD). This practice reduced the need for blood transfusions in infants with critical CHD compared to early cord clamping (ECC).
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
- Obstetrics
Background:
- Delayed umbilical cord clamping (DCC) may improve neonatal health compared to early umbilical cord clamping (ECC).
- The safety and feasibility of DCC in infants with congenital heart disease (CHD) remain underexplored.
- Critical CHD requires careful management strategies during the neonatal period.
Purpose of the Study:
- To assess the safety and feasibility of DCC in neonates diagnosed with critical CHD.
- To compare neonatal outcomes between DCC and ECC in this specific population.
- To establish a foundation for further research into DCC for infants with CHD.
Main Methods:
- A pilot, randomized controlled trial was conducted.
- Pregnant women with critical CHD diagnoses were randomized to either ECC (<10 seconds) or DCC (~120 seconds).
- Infants were monitored for safety measures, including serum bilirubin and hematocrit levels, and need for blood transfusions.
Main Results:
- Thirty infants were randomized; no significant differences in gestational age or surgery timing were observed between groups.
- While no safety concerns were definitively identified, a trend towards higher peak serum bilirubin was noted in the DCC group.
- Infants in the DCC group had higher hematocrits in the first 72 hours and a significantly lower proportion required blood transfusions during hospitalization (43% vs. 7%).
Conclusions:
- Delayed umbilical cord clamping (DCC) is a safe and feasible practice for neonates with critical congenital heart disease.
- DCC was associated with a reduced need for red blood cell transfusions in this cohort.
- Further comprehensive studies are warranted to fully evaluate the benefits of DCC in infants with CHD.
Objective:
Delayed umbilical cord clamping (DCC) at birth may provide a better neonatal health status than early umbilical cord clamping (ECC). However, the safety and feasibility of DCC in infants with congenital heart disease (CHD) have not been tested. This was a pilot, randomized, controlled trial to establish the safety and feasibility of DCC in neonates with CHD.
Study Design:
Pregnant women admitted >37 weeks gestational age with prenatal diagnosis of critical CHD were enrolled and randomized to ECC or DCC. For ECC, the umbilical cord was clamped <10 s after birth; for DCC, the cord was clamped ~120 s after delivery.
Results:
Thirty infants were randomized at birth. No differences between the DCC and ECC groups were observed in gestational age at birth or time of surgery. No differences were observed across all safety measures, although a trend for higher peak serum bilirubin levels (9.2±2.2 vs 7.3±3.2 mg dl(-1), P=0.08) in the DCC group than in the ECC group was noted. Although similar at later time points, hematocrits were higher in the DCC than in the ECC infants during the first 72 h of life. The proportion of infants not receiving blood transfusions throughout hospitalization was higher in the DCC than in the ECC infants (43 vs 7%, log-rank test P=0.02).
Conclusion:
DCC in infants with critical CHD appears both safe and feasible, with fewer infants exposed to red blood cell transfusions than with ECC. A more comprehensive appraisal of this practice is warranted.
