Delayed cord clamping after preterm birth - hype or hope?

[Stefan Johansson 342]

I guess many of you have seen that the Australian placental transfusion study is now published in NEJM.

In this RCT - 1500 infants born <32 weeks were randomized to early vs late clamping (≤10 vs ≥60 sec).

The results were... no clear benefits, the odds ratio was 1.00 (0.88.-1.13) for the combined primary outcome of death or major morbidity.

We have not yet discussed in our NICU how to relate to those findings - we currently practise delayed clamping (at 60 sec).

Thoughts?

[Francesco Cardona 73]

The wrath of combined outcomes!

[chienyichen 10]

I am wondering if any one have experience about milking. 

Our Obs doctors seemed like to do it more.....

[Stefan Johansson 342]

@chienyichen maybe they have read a paper from 2015, a relatively small trial reviewed by @EBNEO , read the link below.

I personally think that paper only shows a proxy outcome and that a larger trial with meaningful clinical outcomes (like RDS, BPD, IVH etc-etc) should show benefits before changing practise. (but we do delayed clamping though )

https://ebneo.org/2015/12/does-umbilical-cord-milking-result-in-higher-measures-of-systemic-blood-flow-in-preterm-infants/

[tarek 56]

WHO recommendation with delayed cord clamping even for 3 minutes

NRP guidlines latest edition with delayed cord clamping from 30 -60 seconds

In preterms: 

Decrease incidence of IVH

Decrease incidence of NEC

Reduce need for transfusion

Avoid hypovolemic hypotension

For full term

Studies showed that improve iron stores in first few months

The American college of obstetrician and gynacologists recommend delayed cord clamping in there commite meeting in 2016