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  • Exposure to umbilical cord management approaches and death or neurodevelopmental impairment at 22–26 months’ corrected age after extremely preterm birth

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Original research
Exposure to umbilical cord management approaches and death or neurodevelopmental impairment at 22–26 months’ corrected age after extremely preterm birth
  1. Sara C Handley1,2,
  2. Neha Kumbhat3,
  3. Barry Eggleston4,
  4. Elizabeth E Foglia2,
  5. Alexis S Davis3,
  6. Krisa Van Meurs3,
  7. Satyan Lakshminrusimha5,
  8. Michele Walsh6,
  9. Kristi L Watterberg7,
  10. Myra H Wyckoff8,
  11. Abhik Das9,
  12. Sara B DeMauro1,2
  1. 1 Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
  2. 2 Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  3. 3 Pediatrics/Neonatology, Stanford University, Stanford, California, USA
  4. 4 Biostatistics and Epidemiology, RTI International, Research Triangle Park, North Carolina, USA
  5. 5 Pediatrics, UC Davis, Davis, California, USA
  6. 6 Department of Pediatrics, University Hospitals Rainbow Babies and Children’s Hospital, 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 Biostatistics, RTI International, Rockville, Maryland, USA
  1. Correspondence to Dr Sara B DeMauro, Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA; DEMAURO{at}chop.edu

Abstract

Objective To compare death or severe neurodevelopmental impairment (NDI) at 22–26 months’ corrected age (CA) among extremely preterm infants following exposure to different forms of umbilical cord management.

Design Retrospective study.

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

Patients Infants born <27 weeks’ gestation in 2016–2018 without severe congenital anomalies who received active treatment after birth and underwent neurodevelopmental assessments between 22 and 26 months’ CA.

Exposures Immediate cord clamping (ICC), delayed cord clamping (DCC) or umbilical cord milking (UCM).

Main outcomes and measure Primary composite outcome of death or severe NDI at 22–26 months’ CA, defined as severe cerebral palsy, Bayley-III cognitive/motor composite score <70, bilateral deafness or blindness; individual components were examined as secondary outcomes. Multivariable regression examined associations, adjusting for risk factors identified a priori and potential confounders. Mediation analysis explored the effect of severe intraventricular haemorrhage (IVH) on the exposure-outcome relationship.

Results Among 1900 infants, 64.1% were exposed to ICC, 27.8% to DCC and 8.1% to UCM. Compared with ICC-exposed infants, DCC-exposed infants had lower odds of death or severe NDI (adjusted OR 0.64, 95% CI 0.50 to 0.83). No statistically significant differences were observed when comparing UCM with either ICC or DCC, or between secondary outcomes across groups. Association between cord management and the primary outcome was not mediated by severe IVH.

Conclusion Compared with ICC, DCC exposure was associated with lower death or severe NDI at 22–26 months’ CA among extremely preterm infants, which was not mediated by severe IVH.

  • neonatology
  • epidemiology

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 https://neonatal.rti.org/index.cfm?fuseaction=DataRequest.Home.

https://doi.org/10.1136/archdischild-2022-324565

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    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 https://neonatal.rti.org/index.cfm?fuseaction=DataRequest.Home.

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    Footnotes

    • SCH and NK are joint first authors.

    • Twitter @sara_c_handley, @KumbhatNeha, @neosatyan

    • Contributors SCH, NK and SBD designed the project and the main conceptual ideas. BE completed the data analysis. SCH, NK, BE, ASD, KVM, EEF, SL, MW, KLW, MHW, AD and SBD interpreted the analysis. SCH and NK equally contributed to the article draft, which was critically revised by ASD, KVM, EEF, SL, MW, KLW, MHW, AD and SBD. National Institute of Child Health and Human Development, Eunice Kennedy Shriver provided the Generic Database for this study. SCH, NK, BE, ASD, KVM, EEF, SL, MW, KLW, MHW, AD, SBD and the Generic Database subcommittee gave the final approval to the version submitted for publication. SBD is guarantor.

    • Funding The Clinical Centers of the NRN receive funding from the NIH (5UG1HD068244-12 to SBD).

    • Competing interests None declared.

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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