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Periventricular/intraventricular hemorrhage following early and delayed umbilical cord clamping. A randomized
G J Hofmeyr1, L Gobetz, P J Bex
1Department of Obstetrics and Gynaecology, Coronation Hospital, Parktown, South Africa.
Insights
Early umbilical cord clamping in low-birthweight neonates did not significantly increase the incidence of periventricular/intraventricular hemorrhage (PVH/IVH). Further research is needed to definitively confirm or reject this hypothesis.
Area of Science:
- Neonatal Medicine
- Obstetrics
- Pediatric Neurology
Background:
- Periventricular/intraventricular hemorrhage (PVH/IVH) is a significant concern in low-birthweight neonates.
- The timing of umbilical cord clamping is a modifiable factor with potential implications for neonatal outcomes.
Purpose of the Study:
- To investigate whether early umbilical cord clamping, compared to delayed clamping, increases the risk of PVH/IVH in low-birthweight infants.
- To test a specific hypothesis regarding cord clamping and hemorrhage incidence.
Main Methods:
- A randomized controlled trial was conducted in three teaching hospitals.
- Participants included women expected to deliver babies weighing less than 2000g.
- Infants were randomly assigned to either immediate or delayed (1-2 min) umbilical cord clamping, with PVH/IVH assessed by ultrasound.
Main Results:
- The incidence of PVH/IVH was 20% in the delayed clamping group (8/40 neonates) and 24% in the early clamping group (11/46 neonates).
- The odds ratio for PVH/IVH with early clamping was 0.80 (95% CI, 0.29 to 2.20), indicating no statistically significant difference.
Conclusions:
- The study did not find evidence to support the hypothesis that early umbilical cord clamping contributes to PVH/IVH in low-birthweight neonates.
- While the current findings do not confirm the hypothesis, further research is recommended before it can be confidently rejected.
Objective:
To test the hypothesis that early compared with delayed clamping of the umbilical cords of low-birthweight babies may increase the incidence of periventricular/intraventricular hemorrhage (PVH/IVH).
Design:
Randomized controlled trial.
Setting:
The labor wards of 3 teaching hospitals of the University of the Witwatersrand, Johannesburg.
Patients:
Women expected to give birth to babies weighing less than 2000 g.
Interventions:
Allocation by randomly ordered, sealed cards to a policy either of clamping the umbilical cord immediately after delivery, or, if possible, delaying cord clamping for 1 to 2 min.
Main Outcome Measures:
Ultrasound diagnosis of PVH/IVH about 24 h after birth by an observer blind to the allocation of each patient.
Results:
PVH/IVH was diagnosed in 8/40 (20%) of neonates following delayed umbilical cord clamping and 11/46 (24%) following early cord clamping (odds ratio 0.80; 95% confidence interval, 0.29 to 2.20).
Conclusions:
This study does not confirm that early clamping of the umbilical cord may contribute to the initiation of PVH/IVH in low-birthweight neonates, but further studies are required before the hypothesis can be rejected with confidence.