Early Versus Delayed Cord Clamping Among Preterms: A Cohort Study

Sanjukta Panda, Nihar Ranjan Mishra, Piyush Shukla, Bijan Kumar Nayak

Abstract

Background: In preterm neonates, the risks and benefits of early cord clamping (ECC) versus delayed cord clamping (DCC) remain a subject of debate, and the optimal timing to clamp the cord is still unclear.

Aim: To compare the effects of ECC and DCC among preterm neonates with respect to morbidities and mortalities

Materials and Methods: This prospective cohort study was conducted from November 2017 to October 2019 on 160 (80/80) neonates, with prior approval from the institutional ethics committee. After confirming for predefined inclusion and exclusion criteria, the neonates were enrolled (based on clamping time) and were divided into 2 groups after receiving written informed consent from their parents or legal heir.

Results: Requirement of phototherapy was high in the DCC group compared with the ECC group (relative risk [RR]: 1.66, 95% CI: 1.06–2.59; P < .01). Requirement of blood transfusion was lower in the DCC group than that in the ECC group (RR: 0.36, 95% CI: 0.19–0.67; P < .001). There was a decreased risk of necrotizing enterocolitis, intraventricular hemorrhage, and mortality in the DCC group compared with the ECC group (RR: 0.24, 95% CI: 0.11–0.51, P < .001; RR: 0.28, 95% CI: 0.09–0.83, P < .012; RR: 0.51, 95% CI: 0.30–0.88, P < .013, respectively). The neonates in the DCC group were discharged earlier because of high median duration of cumulative survival (d) than those in the ECC group, where it was comparatively less (P < .001).

Conclusion: In preterm neonates, DCC resulted in a decreased risk of morbidities and mortalities; however, there is an increased chance for requirement of phototherapy in the DCC group. So, a judicious approach is required by weighing the risk and benefits.