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Placental transfusion and short-term outcomes among extremely preterm infants
  1. Neha Kumbhat1,2,
  2. Barry Eggleston3,
  3. Alexis S Davis2,
  4. Krisa P Van Meurs2,
  5. Sara Bonamo DeMauro4,
  6. Elizabeth E Foglia4,
  7. Satyanarayan Lakshminrusimha5,
  8. Michele C Walsh6,
  9. Kristi L Watterberg7,
  10. Myra H Wyckoff8,
  11. Abhik Das9,
  12. Sara C Handley4
  13. the Generic Database Subcommittee of the NICHD Neonatal Research Network
    1. 1 Neonatology, Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
    2. 2 Division of Neonatology, Lucile Packard Children’s Hospital, Palo Alto, California, USA
    3. 3 Biostatistics and Epidemiology, RTI International, Research Triangle Park, North Carolina, USA
    4. 4 Department of Pediatrics, Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
    5. 5 UC Davis, Davis, California, USA
    6. 6 Pediatrics, Case Western Reserve University, Cleveland, Ohio, USA
    7. 7 Department of Paediatrics, University of New Mexico, Albuquerque, New Mexico, USA
    8. 8 Pediatrics, UT Southwestern Medical Center at Dallas, Dallas, Texas, USA
    9. 9 RTI International, Rockville, Maryland, USA
    1. Correspondence to Dr Sara C Handley, Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA; handleys{at}


    Objective To compare short-term outcomes after placental transfusion (delayed cord clamping (DCC) or umbilical cord milking (UCM)) versus immediate cord clamping among extremely preterm infants.

    Design Retrospective study.

    Setting The Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network registry.

    Patients Infants born <29 weeks’ gestation in 2016 or 2017 without congenital anomalies who received active treatment after delivery.

    Intervention/exposure DCC or UCM.

    Main outcome measures Primary outcomes: (1) composite of mortality or major morbidity by 36 weeks’ postmenstrual age (PMA); (2) mortality by 36 weeks PMA and (3) composite of major morbidities by 36 weeks’ PMA. Secondary composite outcomes: (1) any grade intraventricular haemorrhage or mortality by 36 weeks’ PMA and (2) hypotension treatment in the first 24 postnatal hours or mortality in the first 12 postnatal hours. Outcomes were assessed using multivariable regression, adjusting for mortality risk factors identified a priori, significant confounders and centre as a random effect.

    Results Among 3116 infants, 40% were exposed to placental transfusion, which was not associated with the primary composite outcome of mortality or major morbidity by 36 weeks’ PMA (adjusted OR (aOR) 1.26, 95% CI 0.95 to 1.66). However, exposure was associated with decreased mortality by 36 weeks’ PMA (aOR 0.71, 95% CI 0.55 to 0.92) and decreased hypotension treatment in first 24 postnatal hours (aOR 0.66, 95% CI 0.53 to 0.82).

    Conclusion In this extremely preterm infant cohort, exposure to placental transfusion was not associated with the composite outcome of mortality or major morbidity, though there was a reduction in mortality by 36 weeks’ PMA.

    Trial registration number NCT00063063.

    • epidemiology
    • mortality
    • neonatology
    • outcomes research
    • procedures

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    • Contributors NK, ASD, KPVM, SBD and SCH designed the project and the main conceptual ideas. BE worked on the data analysis. NK, BE, ASD, KPVM, SBD, EEF, SL, MCW, KLW, MHW, AD and SCH worked on the interpretation of this analysis. NK and SCH drafted the article, which was critically revised by ASD, KPVM, SBD, EEF, SL, MCW, KLW, MHW and AD. NICHD, Eunice Kennedy Shriver provided the GDB for this study. NK, BE, ASD, KVM, SBD, EEF, SL, MCW, KLW, MHW, AD, SCH and the GDB subcommittee gave the final approval to the version submitted for publication.

    • 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.

    • Patient consent for publication Not required.

    • Ethics approval This study was performed using the NRN GDB of the Eunice Kennedy Shriver NICHD. Institutional review board approval for the NRN GDB registry was obtained for each centre.

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

    • Data availability statement Data are available on reasonable request. Data reported in this paper may be requested through a data use agreement. Further details are available at