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Am J Perinatol
DOI: 10.1055/a-1845-1816
Original Article

Delayed Cord Clamping for 45 Seconds in Very Low Birth Weight Infants: Impact on Hemoglobin at Birth and Close to Discharge

Barbara Amendolia
1   Division of Neonatology, Department of Pediatrics, The Children's Regional Hospital at Cooper, Camden, New Jersey
,
Nicole Kilic
1   Division of Neonatology, Department of Pediatrics, The Children's Regional Hospital at Cooper, Camden, New Jersey
,
Faraz Afridi
1   Division of Neonatology, Department of Pediatrics, The Children's Regional Hospital at Cooper, Camden, New Jersey
,
Omar Qari
1   Division of Neonatology, Department of Pediatrics, The Children's Regional Hospital at Cooper, Camden, New Jersey
,
Vishwanath Bhat
1   Division of Neonatology, Department of Pediatrics, The Children's Regional Hospital at Cooper, Camden, New Jersey
,
Daniel Nakhla
2   Rutgers University, The State University of NJ, New Brunswick, New Jersey
,
Sara Sadre
1   Division of Neonatology, Department of Pediatrics, The Children's Regional Hospital at Cooper, Camden, New Jersey
,
Rebecca Eckardt
1   Division of Neonatology, Department of Pediatrics, The Children's Regional Hospital at Cooper, Camden, New Jersey
,
Tarek Nakhla   #
1   Division of Neonatology, Department of Pediatrics, The Children's Regional Hospital at Cooper, Camden, New Jersey
,
Vineet Bhandari
1   Division of Neonatology, Department of Pediatrics, The Children's Regional Hospital at Cooper, Camden, New Jersey
,
Zubair H. Aghai 
3   Division of Neonatology, Department of Pediatrics, Thomas Jefferson University/Nemours, Philadelphia, Pennsylvania
› Author Affiliations Funding None.
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Abstract

Objective To assess the impact of delayed cord clamping (DCC) for 45 seconds on hemoglobin at birth and close to discharge in very low birth weight (VLBW) infants and to compare modes of delivery in infants who received DCC.

Study Design In a retrospective study, 888 VLBW infants (≤1,500 g) who survived to discharge and received immediate cord clamping (ICC) were compared with infants who received DCC. Infants who received DCC and born via Cesarean section (C-section) were compared with those born via vaginal birth.

Results A total of 555 infants received ICC and 333 DCC. Only 188 out of 333 VLBW infants (56.5%) born during the DCC period received DCC. DCC was associated with higher hemoglobin at birth (15.9 vs. 14.9 g/dL, p = 0.001) and close to discharge (10.7 vs. 10.1 g/dL, p < 0.001) and reduced need for blood transfusion (39.4 vs. 54.9%, p < 0.001). In the DCC group, hemoglobin at birth and close to discharge was similar in infants born via C-section and vaginal birth.

Conclusion DCC for 45 seconds increased hemoglobin at birth and close to discharge and reduced need for blood transfusion in VLBW infants. DCC for 45 seconds was equally effective for infants born by C-section and vaginal delivery. Approximately 44% of VLBW infants did not receive DCC even after implementing DCC guidelines.

Key Points

  • Studies to date have shown that DCC improves mortality and short- and long-term outcomes in VLBW infants.

  • No consistent guidelines for the duration of DCC in preterm and term neonates.

  • DCC for 45 seconds increased hemoglobin at birth and close to discharge in VLBW infants.

Keywords

preterm - placental transfusion - immediate cord clamping

Disclosure Statement

The authors have no financial relationships or conflict of interest relevant to this article.


Authors' Contributions

B.A. conceptualized and designed the study, searched the literature, extracted and analyzed the data, and drafted the initial manuscript. N.K., O.Q., R.E., F.A., D.N., and S.S. extracted data, and reviewed and revised the manuscript. V. Bhandari, T.N., and V. Bhat critically reviewed the data analysis, and critically reviewed and revised the manuscript. Z.H.A. conceptualized and designed the study, searched the literature, analyzed the data, and critically reviewed and revised the manuscript.

All the authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.


# Current affiliation: CHOP Newborn Services at Virtua Hospital, Voorhees, NJ




Publication History

Received: 04 December 2021

Accepted: 27 April 2022

Accepted Manuscript online:
06 May 2022

Article published online:
07 June 2022

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