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A Comparison of Strategies for Managing the Umbilical Cord at Birth in Preterm Infants.

Authors
  • El-Naggar, Walid1
  • Afifi, Jehier2
  • Dorling, Jon2
  • Bodani, Jaya3
  • Cieslak, Zenon4
  • Canning, Rody5
  • Ye, Xiang Y6
  • Crane, Joan7
  • Lee, Shoo K8
  • Shah, Prakesh S8
  • 1 Division of Neonatal Perinatal Medicine, Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada. Electronic address: [email protected] , (Canada)
  • 2 Division of Neonatal Perinatal Medicine, Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada. , (Canada)
  • 3 Department of Pediatrics, Regina General Hospital, Regina, Saskatchewan, Canada. , (Canada)
  • 4 Department of Pediatrics, Royal Columbian Hospital, New Westminster, British Columbia, Canada. , (Canada)
  • 5 Department of Pediatrics, Moncton Hospital, Moncton, New Brunswick, Canada. , (Canada)
  • 6 Maternal-Infant Care (MiCare) Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada. , (Canada)
  • 7 Department of Obstetrics & Gynecology, Memorial University of Newfoundland, St. John's, Newfoundland, Canada. , (Canada)
  • 8 Maternal-Infant Care (MiCare) Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada. , (Canada)
Type
Published Article
Journal
The Journal of pediatrics
Publication Date
Oct 01, 2020
Volume
225
Identifiers
DOI: 10.1016/j.jpeds.2020.05.018
PMID: 32442446
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

To evaluate the rates of practice, and the associations between different cord management strategies at birth (delayed cord clamping [DCC], umbilical cord milking [UCM], and early cord clamping [ECC]) and mortality or major morbidity, rates of blood transfusion, and peak serum bilirubin in a large national cohort of very preterm infants. We retrospectively studied preterm infants <33 weeks of gestation admitted to the Canadian Neonatal Network between January 2015 and December 2017. Patients who received ECC (<30 seconds), UCM, or DCC (≥30 seconds) were compared. Multiple generalized linear/quantile logistic regression models were used. Of 12 749 admitted infants, 9729 were included; 4916 (50.5%) received ECC, 394 (4.1%) UCM, and 4419 (45.4%) DCC. After adjustment for potential confounders identified between groups in univariate analyses, the odds of mortality or major morbidity were higher in the ECC group when compared with UCM group (aOR, 1.18; 95% CI, 1.03-1.35). Mortality and intraventricular hemorrhage were associated with ECC as compared with DCC (aOR, 1.6 [95% CI, 1.22-2.1] and aOR, 1.29 [95% CI, 1.19-1.41], respectively). The odds of severe intraventricular hemorrhage were higher with UCM compared with DCC (aOR, 1.38; 95% CI, 1.05-1.81). Rates of blood transfusion were higher with ECC compared with UCM and DCC (aOR, 1.67 [95% CI, 1.31-2.14] and aOR, 1.68 [95% CI, 1.35-2.09], respectively), although peak serum bilirubin levels were not significantly different. Both DCC and UCM were associated with better short-term outcomes than ECC; however, the odds of severe intraventricular hemorrhage were higher with UCM compared with DCC. Copyright © 2020 Elsevier Inc. All rights reserved.

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