Randomised trial of cord clamping at very preterm birth: outcomes at 2 years
Armstrong-Buisseret, Lindsay; Powers, Katie; Dorling, Jon; Bradshaw, Lucy; Johnson, Samantha; Mitchell, Eleanor; Duley, Lelia
KATIE POWERS KATIE.POWERS@NOTTINGHAM.AC.UK
LUCY BRADSHAW email@example.com
ELEANOR MITCHELL ELEANOR.MITCHELL@NOTTINGHAM.AC.UK
Objective: To report outcomes at 2 years corrected age for children of women recruited to a trial comparing alternative policies for timing of cord clamping and immediate neonatal care at very preterm birth.
Design: Parallel group randomised (1:1) trial.
Setting: Eight UK tertiary maternity units.
Participants: Two hundred and seventy six babies born to 261 women expected to have a livebirth before 32+0 weeks gestation.
Interventions: Deferred cord clamping (?2 minutes) and immediate neonatal care with cord intact, or immediate (?20 seconds) clamping and immediate neonatal care after clamping.
Main outcome measure: Composite of death or adverse neurodevelopmental outcome at 2 years corrected age.
Results: Six babies born after 35+6 weeks were excluded. At 2 years corrected age, outcome data were not available for a further 52 children, leaving 218 for analysis (115 deferred clamping, 103 immediate clamping). Overall, 24/115 (21%) children allocated deferred clamping died or had an adverse neurodevelopmental outcome compared with 35/103 (34%) allocated immediate clamping; relative risk (RR) 0.61 (95% confidence interval [CI] 0.39 to 0.96); risk difference (RD) -13% (95% CI -25% to -1%). Multiple imputation for missing data gave a RR 0.69 (95% CI 0.44 to 1.09) and RD -9% (95% CI -21% to 2%).
Conclusions: Deferred clamping and immediate neonatal care with cord intact may reduce the risk of death or adverse neurodevelopmental outcome at 2 years of age for children born very premature. Confirmation in larger studies is needed to determine the real benefits and harms.
Armstrong-Buisseret, L., Powers, K., Dorling, J., Bradshaw, L., Johnson, S., Mitchell, E., & Duley, L. (2020). Randomised trial of cord clamping at very preterm birth: outcomes at 2 years. Archives of Disease in Childhood. Fetal and Neonatal Edition, 105(3), 292-298. https://doi.org/10.1136/archdischild-2019-316912
|Journal Article Type||Article|
|Acceptance Date||Jul 17, 2019|
|Online Publication Date||Aug 1, 2019|
|Deposit Date||Jul 29, 2019|
|Publicly Available Date||Aug 2, 2019|
|Journal||Archives of Disease in Childhood - Fetal and Neonatal Edition|
|Publisher||BMJ Publishing Group|
|Peer Reviewed||Peer Reviewed|
|Keywords||Neonatal care with cord intact; Outcomes at 2 years corrected age.|
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