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

Area of Science:

• Neonatalogy
• Perinatology
• Pediatric Hematology

Background:

• Delayed cord clamping (DCC) is a practice that may improve iron status in newborns.
• The benefits and risks of DCC in preterm multiple gestations require further investigation.

Purpose of the Study:

• To evaluate the impact of DCC versus early cord clamping (ECC) on hematocrit levels at 6 hours and 6 weeks postpartum.
• To assess other clinical outcomes, including hospital stay and mortality, in preterm multiple gestations.

Main Methods:

• A randomized controlled trial was conducted in Western India involving preterm multiple gestations.
• Infants were randomized to either DCC (60 seconds) or ECC (within 30 seconds).
• Primary outcome was hematocrit at 6 hours; secondary outcomes included hematocrit at 6 weeks, peak bilirubin, phototherapy duration, and mortality.

Main Results:

• The DCC group showed significantly higher hematocrit levels at both 6 hours (61.9% vs 55.8%) and 6 weeks (55.5% vs 49.6%).
• While not statistically significant, the DCC group had higher peak bilirubin levels and a significantly prolonged duration of phototherapy (93.6 hours vs 61.4 hours).
• Mortality rates were similar between groups (7.5% in DCC vs 11% in ECC).

Conclusions:

• Delayed cord clamping is feasible in preterm multiple gestations and effectively increases hematocrit levels.
• Potential risks associated with DCC include elevated peak bilirubin and increased need for phototherapy.
• Further research is needed to balance the benefits of improved hematocrit against potential adverse effects in this population.