Delayed versus Early Umbilical Cord Clamping in Preterm Multiple Gestation: A Randomized Controlled Trial

The objective of this study is to evaluate the effects of delayed cord clamping (DCC) on hematocrit at 6 hours and 6 weeks of age, hospital stay, and other clinical outcomes at discharge.

This randomized controlled trial was conducted in a tertiary care center in Western India. Preterm multiple gestations were randomized to DCC at 60 seconds of birth or early cord clamping (ECC) within 30 seconds of birth. The primary outcome was hematocrit at 6 hours of age.

A total of 76 mothers and 155 preterm infants of multiple gestation (73 twins and 3 triplets) were randomized. The mean hematocrit at 6 hours was significantly higher in the DCC group (61.9 ± 5.5 vs. 55.8 ± 5.3, N = 155, p < 0.001). Hematocrit at 6 weeks was also significantly higher in the DCC group (55.5 ± 3.8 vs. 49.6 ± 4.5, N = 142, p < 0.001). DCC adherence rate was 88% (n = 70) in the intervention group. Mortality was observed in six infants in the DCC group (7.5%) and eight infants (11%) in the ECC group. Infants in the DCC group had a higher peak bilirubin level, although not statistically significant (13.1 ± 2.3 vs. 11.1 ± 2.5 mg/dL, p = 0.09) and significantly prolonged duration of phototherapy (93.6 ± 32.8 vs. 61.4 ± 38.6 hours, p < 0.001). Other secondary outcomes were similar between the two groups.

DCC was feasible in preterm multiple gestation and resulted in improved hematocrit at 6 hours and 6 weeks of life. There was a nonsignificant trend toward higher peak bilirubin levels in infants who received DCC. This trial is registered with the Clinical Trials Registry of India (identifier: CTRI/2023/10/058944).

· DCC increased hematocrit at 6 hours and 6 weeks in preterm multiple gestation.. · DCC increased peak bilirubin levels and prolonged the duration of phototherapy.. · DCC is feasible in preterm multiple gestation..