- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02092103
Delayed Clamping and Milking the Umbilical Cord in Preterm Infants
December 27, 2018 updated by: TriHealth Inc.
Delayed Clamping and Milking the Umbilical Cord Prior to Clamping in Preterm Infants and the Effect of Neonatal Outcomes
This is a randomized controlled trial that will compare the effects of delayed umbilical cord clamping to umbilical cord milking in preterm infants (less than 34 weeks gestation).
The infants' hemoglobin and hematocrit levels in the Neonatal Intensive Care Unit (NICU) will be evaluated, as well as the rates of necrotizing enterocolitis, intraventricular hemorrhage, and blood transfusions.
The hypothesis is that milking the umbilical cord prior to clamping is superior to simply delayed cord clamping, presumably providing an increased blood volume to the preterm neonate improving its outcomes.
Study Overview
Detailed Description
The optimal timing for clamping the umbilical cord after birth in preterm infants has been a subject of controversy and debate for many years.
It has been until recently the standard practice in ob/gyn to clamp the umbilical cord immediately post delivery to allow for immediate transition resuscitation of the neonate, especially in preterm infants.
Due to the fact that optimal timing for cord clamping has yet to be definitively established in the preterm population, more information is needed.
Immediate cord clamping, however, could preclude the infant from an extra boost in blood volume that may prove beneficial later in the newborn life.
Directly comparing the recently recommended practice of delayed umbilical cord clamping to milking the umbilical cord prior to clamping has the potential to prove beneficial for the neonates in question, as well as change daily obstetrical practices.
In this study all infants below 34 weeks will be randomized into one of two groups: delayed cord clamping and milking the umbilical cord prior to clamping.
The decision was made not to include immediate cord clamping due to a recent American Congress of Obstetricians and Gynecologists (ACOG) recommendation that all preterm infants have their cord clamping be delayed.
Their outcomes will be measured by serial hemoglobin and hematocrit levels while in the NICU, the incidence of necrotizing enterocolitis, incidence of intraventricular hemorrhage, and the need for neonatal blood transfusions.
Study Type
Interventional
Enrollment (Actual)
282
Phase
- Not Applicable
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
-
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Ohio
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Cincinnati, Ohio, United States, 45220
- Good Samaritan TriHealth Hospital
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-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
- Child
- Adult
- Older Adult
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- Admitted to Labor & Delivery at Good Samaritan TriHealth Hospital in Cincinnati, Ohio with expected/possible preterm delivery between 23-34 weeks gestation
- Care provided by Good Samaritan TriHealth Hospital's Faculty Medical Center or Tri-State Maternal Fetal Medicine
Exclusion Criteria:
- Declined to participate
- Known congenital anomalies
- Precipitous delivery preventing completion of the protocol
- Placental abruption around the time of or as indication for delivery
- Mother has uterine rupture
- Non reassuring fetal heart tracing (FHT) immediately prior/leading to delivery
- Multiple gestation
- Parvo B19
- Infants known to be at risk of anemia due to isoimmunization (mother has red blood cell antibodies
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Prevention
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
No Intervention: Delayed Clamping
The American Congress of Obstetricians and Gynecologists (ACOG) recommends delayed cord clamping for preterm infants. Infants randomized to this group will follow the protocol below:
|
|
Experimental: Cord Milking
Infants randomized to the cord milking group will follow the protocol below:
|
See description in cord milking arm.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Hemoglobin and Hematocrit values (H/H) in NICU
Time Frame: NICU admission to discharge, expected average of 50 days
|
All H/H values in the neonatal intensive care unit (NICU) will be recorded.
|
NICU admission to discharge, expected average of 50 days
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Neonatal transfusions
Time Frame: Birth to discharge, expected average of 50 days
|
The incidence of transfusions between the two groups will be compared.
|
Birth to discharge, expected average of 50 days
|
Necrotizing enterocolitis
Time Frame: Birth to discharge, expected average of 50 days
|
The incidence of necrotizing enterocolitis between the two groups will be compared.
|
Birth to discharge, expected average of 50 days
|
Intraventricular hemorrhage
Time Frame: Birth to discharge, expected average of 50 days
|
The incidence of intraventricular hemorrhage between the two groups will be compared.
|
Birth to discharge, expected average of 50 days
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Length of stay
Time Frame: Birth to discharge, expected average of 50 days
|
The length of NICU stay between the two arms will be compared.
|
Birth to discharge, expected average of 50 days
|
Survival to discharge
Time Frame: Birth to discharge, expected average of 50 days
|
The rate of infant survival until discharge will be recorded for both groups.
|
Birth to discharge, expected average of 50 days
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Investigators
- Principal Investigator: Kathleen Smith, MD PhD, TriHealth Inc.
Publications and helpful links
The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start
March 1, 2014
Primary Completion (Actual)
July 8, 2018
Study Completion (Actual)
July 8, 2018
Study Registration Dates
First Submitted
March 13, 2014
First Submitted That Met QC Criteria
March 17, 2014
First Posted (Estimate)
March 19, 2014
Study Record Updates
Last Update Posted (Actual)
December 28, 2018
Last Update Submitted That Met QC Criteria
December 27, 2018
Last Verified
September 1, 2018
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- 13094-14-012
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
NO
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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