Safety and efficacy of delayed umbilical cord clamping in multiple and singleton premature infants - A quality improvement study

Ruangkit, Chayatat; Moroney, V.; Viswanathan, S.; Bhola, Monika

doi:10.3233/npm-15915043

Cited by 19 publications

(18 citation statements)

References 21 publications

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“…8,9 In a meta-analysis of umbilical cord milking, effects on preterm infants included a reduced need for oxygen at 36 weeks and less intraventricular hemorrhage (IVH) of all grades, although there was no difference in mortality. 10 Both delayed cord clamping and umbilical cord milking have been shown to improve hemodynamic stability, [11][12][13][14][15][16] reduce blood transfusion 11,[17][18][19][20][21][22] and inotrope support, 19 and lower rates of morbidity and mortality in very preterm infants. 10,19,20,[23][24][25][26] Despite these benefits, providers at our institution were reluctant to adopt delayed cord clamping due to concerns surrounding delayed resuscitation of early preterm infants.…”

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confidence: 99%

Neonatal Outcomes Associated with Umbilical Cord Milking in Preterm Multiple Gestations

et al. 2019

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Objective Our aim was to evaluate the effect of umbilical cord milking on outcomes for preterm multiples. Study Design We implemented a policy of cord milking in neonates born at less than 30 weeks' gestation in September 2011. We compared cord milking in multiples with a historical cohort. Multivariable logistic regression models estimated the effect of cord milking on a composite neonatal adverse outcome. Secondary outcomes were hematocrit at birth, need for blood transfusion, and inotrope use. Results We identified 149 neonates (120 twins, 29 triplets), 51 historical controls, and 98 neonates with cord milking. Cord milking was associated with a lower rate of adverse composite neonatal outcome in univariable analysis (odds ratio [OR]: 0.36; 95% confidence interval [CI]: 0.15–0.84). However, in multivariable modeling, the effect was not significant (adjusted OR [aOR]: 0.54, 95% CI: 0.23–1.28). Hematocrit was 4.6 unit % (95% CI: 2–7.3) higher in the cord milking group, and cord milking was associated with a lower rate of blood transfusion (aOR: 0.28; 95% CI: 0.1–0.74; p = 0.01). There was no difference in inotrope administration. Conclusion Umbilical cord milking was not associated with a decrease in composite neonatal adverse outcome. However, we observed an increase in hematocrit and decreased need for blood transfusion in neonates with cord milking.

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confidence: 99%

Neonatal Outcomes Associated with Umbilical Cord Milking in Preterm Multiple Gestations

et al. 2019

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“…A QI study showed successful implementation of DCC in 77% of preterm singletons and multiples. Their DCC cohort, which included 25% multiples (n=41), had fewer DR intubations, less metabolic acidosis and higher haematocrits 9. A pre/postintervention study showed that preterm twins receiving DCC required fewer transfusions and surfactant treatment for RDS compared with infants receiving early cord clamping 8…”

Section: Discussionmentioning

confidence: 99%

“…Monochorionic multiples present a unique challenge to implementing DCC due to TTTS complications and concerns about putting the second twin’s well-being at risk while performing DCC on the first. Many studies excluded monochorionic multiples or a subset of those who fit TTTS diagnostic criteria 4 7 9. Studies including monochorionic multiples had very small sample sizes 8 10.…”

Section: Discussionmentioning

confidence: 99%

“…Randomised control trials (RCTs) including multiples have not provided separate outcomes data for multiples 6 7. Observational studies confirmed that DCC was feasible in dichorionic twins <32 weeks’ gestational age (GA)8–10 and was associated with improved neonatal outcomes in multiples 8. These studies did not compare outcomes between first-born and second-born multiples or between monochorionic and dichorionic/trichorionic multiples.…”

Section: Introductionmentioning

confidence: 99%

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Neonatal outcomes in preterm multiples receiving delayed cord clamping

Jegatheesan

Belogolovsky

Nudelman

et al. 2019

Arch Dis Child Fetal Neonatal Ed

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ObjectiveTo compare neonatal outcomes in singletons versus multiples, first-born versus second-born multiples and monochorionic versus dichorionic/trichorionic multiples <33 weeks’ gestational age (GA) who received delayed cord clamping (DCC).DesignRetrospective, observational study of 529 preterm infants receiving ≥30 s DCC. Generalised estimating equations and mixed effects models were used to compare outcomes in singletons versus multiples and monochorionic versus dichorionic/trichorionic multiples. Wilcoxon signed-rank and McNemar tests were used to compare first-born versus second-born multiples.SettingLevel III neonatal intensive care unit, California, USA.Patients433 singletons and 96 multiples <33 weeks’ GA, born January 2008–December 2017, who received DCC.Results86% of multiples and 83% of singletons received DCC. Multiples had higher GA (31.0 weeks vs 30.6 weeks), more caesarean sections (91% vs 54%), fewer males (48% vs 62%) and higher 12–24 hour haematocrits (54.3 vs 50.5) than singletons. Haematocrit difference remained significant after adjusting for birth weight, delivery type and sex. Compared with first-born multiples, second-born multiples were smaller (1550 g vs 1438 g) and had lower survival without major morbidity (91% vs 77%). Survival without major morbidity was not significant after adjusting for birth weight. Compared with dichorionic/trichorionic multiples, monochorionic multiples had slightly lower admission temperatures (37.0°C vs 36.8°C), although this difference was not clinically significant. There were no other differences in delivery room, respiratory, haematological or neonatal outcomes between singletons and multiples or between multiples’ subgroups.ConclusionsNeonatal outcomes in preterm infants receiving DCC were comparable between singletons and multiples, first and second order multiples and monochorionic and dichorionic/trichorionic multiples.

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“…Although several studies on DCC have included infants of multiple gestations together with singletons, the number of infants in each study was too small to draw a conclusion regarding the benefits of DCC in this patient population [6-11]. Despite insufficient evidence in the literature to recommend or oppose DCC in infants of multiple gestations [12], DCC is performed routinely in these infants at some institutions [9]. Therefore, we performed this RCT to compare the outcomes of ICC and DCC in multiple-birth preterm infants.…”

Section: Introductionmentioning

confidence: 99%

A Randomized Controlled Trial of Immediate versus Delayed Umbilical Cord Clamping in Multiple-Birth Infants Born Preterm

et al. 2018

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Background: Delayed cord clamping (DCC) improves placental transfusion and increases blood volume in preterm infants when compared with immediate cord clamping (ICC). However, evidence to support DCC in multiple-birth preterm infants is still lacking. Objective: To compare the outcomes of ICC versus DCC in preterm infants of multiple births. Study Design: Women with a multiple pregnancy, including twins and triplets with a gestational age of 28–36 weeks, were randomized to receive ICC (23 women and 50 infants) or DCC for 30–60 s (24 and 51 infants). The infants’ hematocrit on admission, superior vena cava (SVC) flow measured within 24 h, and hematocrit at 8 weeks of age were compared. The use of uterotonic agents during delivery was not controlled in this study. Result: All infants were delivered by cesarean section (CS) except for 2 sets of twins, 1 in each group. Maternal and infant baseline characteristics in both groups were comparable. There were no significant differences between the groups in admission hematocrit, SVC flow measured within 24 h, hematocrit at 8 weeks of age, or any other neonatal outcomes. The incidence of maternal postpartum hemorrhage (PPH) was higher in the DCC group (4.3% in ICC vs. 25% in DCC, p = 0.04). Conclusion: DCC for 30–60 s did not improve placental transfusion or increase systemic blood flow in multiple-birth infants born preterm, mostly by CS, when compared with ICC. The finding of a higher PPH rate in the DCC group raises concerns about the maternal safety of this procedure in this patient population.

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Safety and efficacy of delayed umbilical cord clamping in multiple and singleton premature infants - A quality improvement study

Cited by 19 publications

References 21 publications

Neonatal Outcomes Associated with Umbilical Cord Milking in Preterm Multiple Gestations

Neonatal Outcomes Associated with Umbilical Cord Milking in Preterm Multiple Gestations

Neonatal outcomes in preterm multiples receiving delayed cord clamping

A Randomized Controlled Trial of Immediate versus Delayed Umbilical Cord Clamping in Multiple-Birth Infants Born Preterm

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