Effect of Novel Placental Transfusion Technique—Gravity-Aided Cord Blood Transfusion at Birth on Hemoglobin Levels in Preterm Infants Born Less than 30 Weeks: A Randomized Controlled Trial

Abstract

Introduction Delayed cord clamping (DCC) is considered standard of practice in very preterm deliveries but could not be practiced in more than 50%, as they need resuscitation measures. We studied the effect of a novel technique of placental transfusion, gravity aided cord blood transfusion (GCT) in comparison to standard care in preterm <30 weeks of gestation on hemoglobin levels at 24 hours of life. Methods This randomized noninferiority trial was conducted in a tertiary care unit from September 2020 to June 2021 in South India. Preterm infants with gestational age (GA) <30 weeks were randomized to either GCT or standard care. GCT was performed by clamping the cord with maximal length immediately after birth, shifting the baby to radiant warmer and holding the whole length of the umbilical cord attached to the baby vertically upwards, allowing blood to drain by gravity while the steps of resuscitation were being performed simultaneously. Standard care was either DCC in vigorous babies and immediate cord clamping (ICC) in nonvigorous babies. Primary outcome was hemoglobin levels at 24 hours of birth. The study was terminated in view of slow recruitment due to covid pandemic. Results Twenty two babies were included. Nine babies were in the GCT group. The median (IQR) hemoglobin at 24 hours of life was 16.9 (16.3-18.9) in the GCT group and 16.4 (14.8-17.8) in standard care; the difference was not statistically significant ( P = .4). Higher hemoglobin at 24 hours of life was observed in GCT group with median (IQR) of 16.9 (16.3-18.9) compared to the ICC group with median (IQR) of 15.55 (14.5-17.1), though not statistically significant ( P = .095). Conclusion The novel placental transfusion strategy, namely GCT, is feasible in preterm neonates. Hemoglobin level at 24 hours was not significantly different between GCT and standard care groups. There is a need for large RCT to assess the effect of GCT on other important clinical outcomes in preterm neonates.