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Delayed Cord Clamping Uptake and Outcomes for Infants Born Very Preterm in California
Mary K Quinn1, Anup Katheria2, Mihoko Bennett1
1Department of Pediatrics, Stanford University, Stanford, California.
Insights
Delayed cord clamping (DCC) significantly reduces mortality in very preterm infants. Hospitals with higher DCC rates showed lower preterm infant mortality, confirming DCC
Area of Science:
- Neonatalogy
- Perinatal Medicine
- Public Health
Background:
- Delayed cord clamping (DCC) is a practice with purported benefits for newborns.
- Its impact on mortality and intraventricular hemorrhage (IVH) in preterm infants in real-world settings requires investigation.
Purpose of the Study:
- To determine if delayed cord clamping (DCC) reduces mortality and intraventricular hemorrhage (IVH) in preterm neonates.
- To assess the translation of DCC benefits from clinical trials into clinical practice.
Main Methods:
- A prospective cohort study of 13,094 very preterm infants admitted to 130 California NICUs (2016-2020).
- Individual-level and hospital-level analyses using log-binomial and Poisson regression models, respectively, controlling for confounders.
Main Results:
- DCC was associated with a 43% lower risk of mortality in very preterm infants (aRR: 0.57).
- Increased hospital DCC rates correlated with lower hospital mortality rates (aRR: 0.96).
- DCC showed an association with severe IVH at the individual level but not at the hospital level.
Conclusions:
- Delayed cord clamping (DCC) is linked to reduced mortality in very preterm infants in California NICUs.
- Findings suggest DCC's benefits observed in trials are translating into improved survival in practice.
- DCC did not demonstrate a significant association with IVH at the hospital level.
Objective:
The aim of this study is to investigate whether the purported benefits of delayed cord clamping (DCC) translate into a reduction in mortality and intraventricular hemorrhage (IVH) among preterm neonates in practice.
Study Design:
This was a prospective cohort study of very preterm infants constructed from data from the California Perinatal Quality Care Collaborative for infants admitted into 130 California neonatal intensive care units (NICUs) within the first 28 days of life from 2016 through 2020. Individual-level analyses were conducted using log-binomial regression models controlling for confounders and allowing for correlation within hospitals to examine the relationship of DCC to the outcomes of mortality and IVH. Hospital-level analyses were conducted using Poisson regression models with robust variance controlling for confounders.
Results:
Among 13,094 very preterm infants included (5,856 with DCC and 7,220 without), DCC was associated with a 43% lower risk of mortality (adjusted risk ratio [aRR]: 0.57; 95% confidence interval [CI]: 0.47-0.66). Furthermore, every 10% increase in the hospital rate of DCC among preterm infants was associated with a 4% lower hospital mortality rate among preterm infants (aRR: 0.96; 95% CI: 0.96-0.99). DCC was associated with severe IVH at the individual level, but not at the hospital level.
Conclusion:
At the individual level and hospital level, the use of DCC was associated with lower mortality among preterm infants admitted to NICUs in California. These findings are consistent with clinical trial results, suggesting that the effects of DCC seen in clinical trials are translating to improved survival in practice.
Key Points:
· DCC was associated with lower mortality among very preterm newborns in California.. · Hospitals using DCC more often had lower very preterm mortality.. · DCC was not associated with IVH at the hospital level..
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