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Published on: June 29, 2013
Effects of delayed cord clamping in intrauterine growth-restricted neonates: a randomized controlled trial
Kanhu Charan Digal1, Poonam Singh1, Yash Srivastava2
1Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India.
Insights
Delayed cord clamping (DCC) improves systemic blood flow and iron levels in intrauterine growth-restricted (IUGR) neonates. This safe intervention increases blood flow and hematocrit without raising risks of polycythemia or phototherapy needs.
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
- Perinatal Research
Background:
- The optimal timing for umbilical cord clamping in intrauterine growth-restricted (IUGR) neonates is not well-established.
- Delayed cord clamping (DCC) has shown benefits in preterm infants but concerns remain regarding potential risks in IUGR neonates.
Purpose of the Study:
- To compare the effects of delayed cord clamping (DCC) versus early cord clamping (ECC) on systemic blood flow and cerebral hemodynamics in IUGR neonates.
- To evaluate the safety and efficacy of DCC in IUGR infants.
Main Methods:
- A randomized controlled trial involving IUGR neonates (gestational age ≥28 weeks) not requiring resuscitation.
- Infants were randomized to DCC (clamping after 60s) or ECC (clamping within 30s).
- Primary outcome was superior vena cava (SVC) blood flow at 24±2h; secondary outcomes included various hemodynamic parameters, hematocrit, bilirubin levels, and clinical outcomes.
Main Results:
- DCC significantly increased SVC blood flow, right ventricular output (RVO), superior mesenteric artery blood flow velocity (SMA-BFV), venous hematocrit, and serum ferritin levels compared to ECC.
- While peak total serum bilirubin (TSB) was higher with DCC, the duration of phototherapy was comparable.
- Incidences of polycythemia, intraventricular hemorrhage, and other adverse outcomes were similar between the groups.
Conclusions:
- Delayed cord clamping is a safe and beneficial intervention for IUGR neonates.
- DCC improves systemic blood flow, SMA-BFV, hematocrit, and serum ferritin levels.
- DCC does not increase the risk of polycythemia or the need for phototherapy for hyperbilirubinemia in this population.
Abstract:
The time of cord clamping in intrauterine growth-restricted (IUGR) neonates remains an area of uncertainty. This assessor-blinded randomized controlled trial compared the effects of delayed cord clamping (DCC) with early cord clamping (ECC) on the systemic blood flow (SBF) and cerebral hemodynamics in IUGR neonates of gestational age ≥28 weeks, not requiring resuscitation. Eligible newborns were randomized to DCC (cord clamping after 60 s; n=55) or ECC (cord clamping within 30 s; n=55) group immediately after delivery. The primary outcome variable was superior vena cava (SVC) blood flow at 24±2 h. The secondary outcome variables were right ventricular output (RVO), anterior cerebral artery (ACA) blood flow velocity (BFV), superior mesenteric artery (SMA)-BFV and venous hematocrit at 24±2 h, peak total serum bilirubin (TSB), incidences of polycythemia, intraventricular hemorrhage, respiratory distress, feeding intolerance, and necrotizing enterocolitis, outcome, duration of hospital stay, screening audiometry, and serum ferritin levels at the postnatal age of 3 months. Compared to ECC, DCC was associated with significantly higher SVC flow (101.22±21.02 and 81.27±19.12 mL/kg/min, in DCC and ECC groups, respectively; p<0.0001), and significantly increased RVO, SMA-BFV, venous hematocrit, and serum ferritin levels. Though peak TSB was significantly higher with DCC, duration of phototherapy was comparable. ACA-BFV, incidence of polycythemia, and other outcomes were comparable between the groups.Conclusions: DCC was a safe and beneficial intervention in IUGR infants with an improved SBF and SMA-BFV and an increased hematocrit and serum ferritin levels without higher incidences of polycythemia and requirement of phototherapy for significant hyperbilirubinemia.Trial registration: Clinical Trials Registry of India (CTRI/2019/05/018904) What is Known: • Delayed cord clamping (DCC) increases superior vena cava (SVC) blood flow in preterm neonates. • DCC increases hematocrit and serum ferritin in intrauterine growth-restricted (IUGR) neonates, but there may be an associated risk of polycythemia and neonatal hyperbilirubinemia. What is New: • DCC increases SVC blood flow, right ventricular output, superior mesenteric artery blood flow velocity, venous hematocrit, and serum ferritin in IUGR neonates. • Incidences of polycythemia and duration of phototherapy for significant neonatal hyperbilirubinemia do not increase with DCC.
