Duley, Lelia, Dorling, Jon, Pushpa-Rajah, Angela, Oddie, Sam J., Yoxall, Charles W., Schoonakker, Bernard, Bradshaw, Lucy, Mitchell, Eleanor J. and Fawke, Joe
(2017)
Randomised trial of cord clamping and initial stabilisation
at very preterm birth.
Archives of Disease in Childhood, 103
(1).
F6-F14.
ISSN 1468-2044
Full text not available from this repository.
Abstract
Objectives: For very preterm births, to compare alternatives policies for umbilical cord clamping and immediate neonatal care.
Design: Parallel group randomised (1:1) trial, using sealed opaque numbered envelopes.
Setting: Eight UK tertiary maternity units.
Participants: 261 women expected to have a livebirth before 32 weeks, and their 276 babies.
Interventions: Cord clamping after at least two minutes and immediate neonatal care with cord intact, or clamping within 20 seconds and immediate neonatal care after clamping.
Main outcome measures: Intraventricular haemorrhage (IVH), death before discharge.
Results: 132 women (137 babies) were allocated clamping ≥2 minutes and neonatal care cord intact, and 129 (139) clamping ≤20 and neonatal care after clamping; 6 mother infant dyads were excluded (2, 4) as birth was after 35+6 weeks, 1 withdrew (death data only available) (0, 1). Median gestation was 28.9 weeks for those allocated clamping ≥2 minutes, and 29.2 for those allocated clamping ≤20 seconds. Median time to clamping was 120 and 11 seconds respectively. 7 of 135 infants (5.2%) allocated clamping ≥2 minutes died and 15 of 135 (11.1%) allocated clamping ≤20 seconds; risk difference (RD) -5.9% (95% confidence interval -12.4% to 0.6%). Of livebirths, 43 of 134 (32%) had IVH versus 47 of 132 (36%) respectively; RD -3.5% (-14.9% to 7.8%). There were no clear differences in other outcomes for infants or mothers.
Conclusions: This is promising evidence that clamping after at least 2 minutes and immediate neonatal care with cord intact at very preterm birth may improve outcome; a large trial is urgently needed.
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