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Delayed cord clamping in Rh-alloimmunised infants: a randomised controlled trial
Tanushree Sahoo1, Anu Thukral2, M Jeeva Sankar1
1Department of Pediatrics, Division of Neonatology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
European Journal of Pediatrics
|January 25, 2020
Summary
Delayed cord clamping in Rh-alloimmunised infants improves packed cell volume (PCV) at 2 hours of birth. This practice shows no significant increase in adverse effects, suggesting a safe method for managing these newborns.
Area of Science:
- Neonatal Medicine
- Hematology
- Immunology
Background:
- Rh alloimmunisation is a significant cause of neonatal complications, including hyperbilirubinaemia and anaemia.
- Delayed cord clamping (DCC) is standard practice but not widely adopted for Rh-alloimmunised infants due to limited evidence.
- Early cord clamping is often preferred in Rh-alloimmunised infants to mitigate potential risks.
Purpose of the Study:
- To evaluate the effect of delayed cord clamping (DCC) versus early cord clamping (ECC) on Rh-alloimmunised infants.
- To assess the primary outcome of venous packed cell volume (PCV) at 2 hours post-birth.
- To investigate secondary outcomes including exchange transfusion, phototherapy, echocardiography parameters, and blood transfusion needs.
Main Methods:
- A randomized controlled trial comparing DCC and ECC in infants of 28- to 41-week gestation.
- Infants were allocated to either the DCC group (N=36) or ECC group (N=34).
- Primary outcome: PCV at 2 hours; Secondary outcomes: incidence of exchange transfusion, phototherapy duration, echocardiography, and blood transfusion up to 14 weeks.
Main Results:
- The DCC group showed a significantly higher mean PCV at 2 hours (48.4% ± 9.2) compared to the ECC group (43.5% ± 8.7).
- No significant differences were observed in the incidence of double volume exchange transfusion (DVET), partial exchange transfusion (PET), duration of phototherapy (PT), echocardiography parameters, or blood transfusion (BT) until 14 weeks.
- Baseline characteristics including gestational age and birth weight were comparable between the groups.
Conclusions:
- Delayed cord clamping (DCC) in Rh-alloimmunised infants effectively improves packed cell volume (PCV) at 2 hours of age.
- DCC was found to be safe, with no significant increase in adverse effects such as exchange transfusion or prolonged phototherapy.
- The findings support the consideration of DCC as a beneficial practice for Rh-alloimmunised neonates.
