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Neonatal outcomes in preterm multiples receiving delayed cord clamping
  1. Priya Jegatheesan1,2,
  2. Esther Belogolovsky1,
  3. Matthew Nudelman1,
  4. Dongli Song1,2,
  5. Balaji Govindaswami1,2
  1. 1 Department of Pediatrics, Newborn Medicine, Santa Clara Valley Medical Center, San Jose, California, USA
  2. 2 Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
  1. Correspondence to Dr Priya Jegatheesan, Department of Pediatrics, Santa Clara Valley Medical Center, San Jose CA 95128, USA; priya.jegatheesan{at}


Objective To compare neonatal outcomes in singletons versus multiples, first-born versus second-born multiples and monochorionic versus dichorionic/trichorionic multiples <33 weeks’ gestational age (GA) who received delayed cord clamping (DCC).

Design Retrospective, observational study of 529 preterm infants receiving ≥30 s DCC. Generalised estimating equations and mixed effects models were used to compare outcomes in singletons versus multiples and monochorionic versus dichorionic/trichorionic multiples. Wilcoxon signed-rank and McNemar tests were used to compare first-born versus second-born multiples.

Setting Level III neonatal intensive care unit, California, USA.

Patients 433 singletons and 96 multiples <33 weeks’ GA, born January 2008–December 2017, who received DCC.

Results 86% of multiples and 83% of singletons received DCC. Multiples had higher GA (31.0 weeks vs 30.6 weeks), more caesarean sections (91% vs 54%), fewer males (48% vs 62%) and higher 12–24 hour haematocrits (54.3 vs 50.5) than singletons. Haematocrit difference remained significant after adjusting for birth weight, delivery type and sex. Compared with first-born multiples, second-born multiples were smaller (1550 g vs 1438 g) and had lower survival without major morbidity (91% vs 77%). Survival without major morbidity was not significant after adjusting for birth weight. Compared with dichorionic/trichorionic multiples, monochorionic multiples had slightly lower admission temperatures (37.0°C vs 36.8°C), although this difference was not clinically significant. There were no other differences in delivery room, respiratory, haematological or neonatal outcomes between singletons and multiples or between multiples’ subgroups.

Conclusions Neonatal outcomes in preterm infants receiving DCC were comparable between singletons and multiples, first and second order multiples and monochorionic and dichorionic/trichorionic multiples.

  • delayed cord clamping
  • multiples
  • preterm
  • second-born multiple
  • monochorionic multiple

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  • Contributors PJ, DS and BG conceived the idea and developed the methodology. EB assisted in data collection, statistical analysis and wrote the first draft of the manuscript. MN performed the statistical analysis. All authors developed and approved the final manuscript. This publication is the work of the authors, and PJ will serve as guarantor for the contents of this paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval The data collection for this retrospective study was approved by our Institutional Review Board as a Quality Improvement project evaluating the outcomes of very preterm infants.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The data sets used and analysed for this study will be made available on request.

  • Patient consent for publication Not required.

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