Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Immediate and Delayed Cord Clamping in Infants Born Between 24 and 32 Weeks: A Pilot Randomized Controlled Trial

Journal of Perinatology volume 23, pages 466–472 (2003)Cite this article

Abstract

OBJECTIVE: This pilot study's aim was to establish feasibility of a protocol for delayed cord clamping (DCC) versus immediate cord clamping (ICC) at preterm birth and to examine its effects on initial blood pressure and other outcomes.

STUDY DESIGN: A randomized controlled trial recruited 32 infants between 24 and 32 weeks. Immediately before delivery, mothers were randomized to ICC (cord clamped at 5 to 10 seconds) or DCC (30- to 45-second delay in cord clamping) groups.

RESULTS: Intention-to-treat analyses revealed that the DCC group were more likely to have higher initial mean blood pressures (adjusted OR 3.4) and less likely to be discharged on oxygen (adjusted OR 8.6). DCC group infants had higher initial glucose levels (ICC=36 mg/dl, DCC=73.1 mg/dl; p=0.02).

CONCLUSION: The research design is feasible. The immediate benefit of improved blood pressure was confirmed and other findings deserve consideration for further study.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1

Similar content being viewed by others

References

  1. Kinmond S, Aitchison TC, Holland BM, et al. Umbilical cord clamping and preterm infants: a randomized trial. BMJ 1993;306:172–175.

    Article  CAS  Google Scholar 

  2. McDonnell M, Henderson-Smart DJ . Delayed umbilical cord clamping in preterm infants: a feasibility study. J Paediatr Child Health 1997;33:308–310.

    Article  CAS  Google Scholar 

  3. Narendra A, Beckett C, Aitchison T, et al. Is it possible to promote placental transfusion (PTFx) at preterm delivery? Pediatr Res 1998;44:454 (Abstract).

    Article  Google Scholar 

  4. Nelle M, Fischer S, Conze S, Beedgen B, Grischke EM, Linderkamp O . Effects of late cord clamping on circulation in prematures (VLBWI). Pediatr Res 1998;44:454 (Abstract).

    Article  Google Scholar 

  5. Rabe H, Wacker A, Hulskamp G, Hornig-Franz I, Jorch G . Late cord clamping benefits extrauterine adaptation. Pediatr Res 1998;44:454 (Abstract).

    Article  Google Scholar 

  6. Rabe H, Wacker A, Hulskamp G, et al. A randomised controlled trial of delayed cord clamping in very low birth weight preterm infants. Eur J Pediatr 2000;159(10):775–777.

    Article  CAS  Google Scholar 

  7. Ibrahim HM, Krouskop RW, Lewis DF, Dhanireddy R . Placental transfusion: umbilical cord clamping and preterm infants. J Perinatol 2000;20:351–354.

    Article  CAS  Google Scholar 

  8. Yao AC, Moinian M, Lind J . Distribution of blood between the infant and the placenta after birth. Lancet 1969;7626(2):871–873.

    Article  Google Scholar 

  9. Waldrop CAJ, Holland BM . The roles and vital importance of placental blood to the newborn infant. J Perinat Med 1995;23:139–143.

    Article  Google Scholar 

  10. World Medical Association Recommendations Guiding Physicians in Biomedical Research: Declaration of Helsinki. http://www.wma.net//policy/17-c_e.html.

  11. Richardson DK, Corcoran JD, Escobar GJ, Lee SK . SNAP-II and SNAPPE-II: simplified newborn illness severity and mortality risk scores. J Pediatr 2001;138(1):92–100.

    Article  CAS  Google Scholar 

  12. Ebbutt A, Frith L . Practical issues in equivalence trials. Stat Med 1998;17:1691–1701.

    Article  CAS  Google Scholar 

  13. Friedman L, Furberg C, DeMets D . Fundamentals of Clinical Trials. 3rd ed. New York: Springer; 1998.

  14. Lindner W, Vobeck S, Hummler H, Pohlandt F . Delivery room management of extremely low birth weigth infants spontaneous breathing or intubation? Pediatrics 1999;103(5):961–967.

    Article  CAS  Google Scholar 

  15. Oh W, Lind J, Gessner IH . Circulatory and respiratory adaptation to early and late cord clamping in newborn infants. Acta Paediatr Scand 1966;55:17–25.

    Article  CAS  Google Scholar 

  16. Tsuru A, Mizuguchi M, Takashima S . Cystic leukomalacia in the cerebellar folia of premature infants. Acta Neuropathol (Berl) 1995;94(4):400–402.

    Article  Google Scholar 

  17. Arroe M, Peitersen B . Retinopathy of prematurity: review of a seven-year period in a Danish neonatal intensive care unit. Acta Pediatr 1994;83(5):501–505.

    Article  CAS  Google Scholar 

  18. Murphy D, Hope P, Johnson A . Neonatal risk factors for cerebral palsy in very preterm babies: case control study. BMJ 1997;314(7078):404–408.

    Article  CAS  Google Scholar 

  19. Polin R, Fox W . Fetal and Neonatal Physiology. 2nd ed. Philadelphia: WB Saunders Company; 1998.

    Google Scholar 

  20. Dixon LR . The complete blood count: physiologic basis and clinical usage. J Perinat Neonatal Nurs 1997;11(3):1–18.

    Article  CAS  Google Scholar 

  21. Callahan DJ, Engle MJ, Volpe JJ . Hypoxic injury to developing glial cells: protective effect of high glucose. Pediatr Res 1990;27(2):186–190.

    Article  CAS  Google Scholar 

  22. Jaykka S . Capillary erection and the structural appearance of fetal and neonatal lungs. Acta Paediatr 1958;47:484–500.

    Article  CAS  Google Scholar 

  23. Porges SW . Vagal tone: a physiologic marker of stress vulnerability. Pediatrics 1992;90(3):498–504.

    CAS  PubMed  Google Scholar 

  24. Mercer JS, Skovgaard R . Neonatal transitional physiology: a new paradigm. J Perinat Neonatal Nurs 2002;15(4):56–75.

    Article  Google Scholar 

  25. Clark R, Slutsky A, Gertsmann D . Lung protective strategies of ventilation in the neonate: what are they? Pediatrics 2000;105(1):112–114.

    Article  CAS  Google Scholar 

  26. Jones JG, Holland BM, Hudson IR, Wardrop CA . Total circulating red cells versus haematocrit as the primary descriptor of oxygen transport by the blood. Br J Haematol 1990;76(2):288–294.

    Article  CAS  Google Scholar 

  27. Wardrop CAJ, Holland BM, Jones JG . Consensus on red cell transfusion. BMJ 1995;311:962–963.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. College of Nursing, University of Rhode Island, Kingston, RI, USA

    Judith S. Mercer CNM, DNSc & Margaret M. McGrath RN, DNSc

  2. Women and Infants' Hospital, Providence, RI, USA

    Margaret M. McGrath RN, DNSc, Angelita Hensman RN, BSN, Helayne Silver MD & William Oh MD

  3. Brown Medical School, Providence, RI, USA

    Helayne Silver MD & William Oh MD

Authors
  1. Judith S. Mercer CNM, DNSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Margaret M. McGrath RN, DNSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Angelita Hensman RN, BSN
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Helayne Silver MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. William Oh MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

Statistical Consultation: Walter Heber, M.Sc., Research Statistician, Division of Research, Department of Obstetrics and Gynecology, Women and Infants Hospital, Providence, Rhode Island.

Funding sources: Sigma Theta Tau, Epsilon Chapter; University of Rhode Island Foundation and College of Nursing

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mercer, J., McGrath, M., Hensman, A. et al. Immediate and Delayed Cord Clamping in Infants Born Between 24 and 32 Weeks: A Pilot Randomized Controlled Trial. J Perinatol 23, 466–472 (2003). https://doi.org/10.1038/sj.jp.7210970

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.jp.7210970

This article is cited by

Search

Advanced search

Quick links