Cord Clamping Among Neonates With Congenital Heart Disease (CORD-CHD)

July 31, 2025 updated by: Carl Backes, MD

CORD-CHD: Clamp OR Delay Among Neonates With Congenital Heart Disease

The goal of this clinical trial is to compare 2 different timepoints for clamping the umbilical cord at birth for term-born infants with a prenatal diagnosis of congenital heart disease (CHD). The main questions it aims to answer are:

  • Does Delayed Cord Clamping at 120 seconds (DCC-120) or Delayed Cord Clamping at 30 seconds (DCC-30) after birth lead to better health outcomes?
  • Does DCC-120 seconds or DCC-30 seconds after birth lead to better neuromotor outcomes at 22-26 months of infant age (postnatal)?

Participants will be asked to do the following:

  • Participate in either DCC-120 or DCC-30 at birth (randomized assignment).
  • Complete General Movements Assessment (GMA) at 3-4 months of infant age (postnatal), complete questionnaires / surveys at this time.
  • Complete questionnaires / surveys at 9-12 months of infant age (postnatal).
  • Complete Hammersmith Infant Neurological Examination (HINE), Developmental Assessment of Young Children 2 Edition (DAYC-2), and questionnaires / surveys at 22-26 months of infant age (postnatal).
  • Permit data collection from electronic medical records for both the mother and infant study participants.

Investigators will compare DCC-120 vs. DCC-30 to see which approach is more beneficial to both the mother and baby with CHD.

Study Overview

Detailed Description

  • AIM 1: Test the hypothesis that, among neonates with prenatally diagnosed significant CHD (ranking of 3 - 6 on the Fetal Cardiovascular Disease Severity Score [FCDSS]), DCC-120 results in lower global rank score (GRS), indicative of better health outcomes, compared with DCC-30.
  • AIM 2: Test the hypothesis that, among neonates with prenatally diagnosed significant CHD (ranking from 3 - 6 on the Fetal Cardiovascular Disease Severity Score [FCDSS]), DCC-120 will result in better neuromotor outcomes at 22-26 months postnatal than DCC-30.

Study Type

Interventional

Enrollment (Estimated)

500

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 Contact

Study Contact Backup

Study Locations

    • Alberta
      • Edmonton, Alberta, Canada
        • Recruiting
        • Stollery Children's Hospital, University of Alberta
        • Contact:
    • Nova Scotia
    • Ontario
      • Toronto, Ontario, Canada
        • Not yet recruiting
        • The Hospital for Sick Children
        • Contact:
    • Alabama
      • Birmingham, Alabama, United States, 35233
        • Recruiting
        • Children's of Alabama
        • Contact:
    • California
      • Los Angeles, California, United States, 90048
      • Orange, California, United States, 92868
        • Not yet recruiting
        • Children's Hospital of Orange County
        • Contact:
      • Palo Alto, California, United States, 94304
        • Not yet recruiting
        • Lucile Packard Children's Hospital Stanford
        • Contact:
      • San Diego, California, United States, 92123
        • Recruiting
        • Sharp Mary Birch Hospital for Woman and Newborns
        • Principal Investigator:
          • Anup Katheria, MD
        • Contact:
        • Contact:
        • Principal Investigator:
          • Jenny Koo, MD
    • Florida
      • Gainesville, Florida, United States, 32608
        • Recruiting
        • UF Health Shands Children's Hospital
        • Contact:
    • Maryland
      • Baltimore, Maryland, United States, 21287
        • Recruiting
        • Johns Hopkins Children's Center
        • Contact:
    • Mississippi
      • Jackson, Mississippi, United States, 39216
        • Recruiting
        • Children's of Mississippi
        • Contact:
    • Missouri
      • Kansas City, Missouri, United States, 64108
        • Recruiting
        • The Children's Mercy Hospital
        • Contact:
      • Saint Louis, Missouri, United States, 63104
    • North Carolina
      • Durham, North Carolina, United States, 27705
        • Recruiting
        • Duke Children's Hospital & Health Center
        • Contact:
        • Principal Investigator:
          • Kevin Hill, MD
    • Ohio
      • Columbus, Ohio, United States, 43205
    • Pennsylvania
      • Philadelphia, Pennsylvania, United States, 19104
        • Recruiting
        • Children's Hospital of Philadelphia
        • Contact:
    • South Carolina
      • Columbia, South Carolina, United States, 29209
        • Recruiting
        • Medical University of South Carolina
        • Contact:
    • Tennessee
      • Nashville, Tennessee, United States, 37232
    • Texas
      • Houston, Texas, United States, 77030
      • San Antonio, Texas, United States, 78229
        • Recruiting
        • University of Texas Health Science Center at San Antonio
        • Contact:
    • Utah
      • Salt Lake City, Utah, United States, 84113

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

Accepts Healthy Volunteers

No

Description

Inclusion criteria are listed below and will be confirmed prior to randomization:

  1. Fetal diagnosis of congenital heart disease (CHD) by prenatal ultrasound / echocardiography from local fetal ECHO, conducted on or after 18 weeks of gestation and prior to randomization. The study fetal diagnosis of CHD must be rated as 3 - 6 on the Fetal Cardiovascular Disease Severity Score (FCDSS), as determined by independent evaluators at the CORD-CHD trial ECHO Core at the Children's Hospital of Philadelphia (to determine final FCDSS eligibility for randomization).

    For each potential participant that has provided consent, the most relevant diagnostic prenatal ultrasound will be uploaded (shared) between 32 weeks of gestation and randomization for review by the ECHO Core. The ECHO Core will make the final FCDSS determination for eligibility status and stratification assignment.]

    [NOTE: A fetal diagnosis of CHD rated as 3 - 6 FCDSS per local review, including borderline cases, will be used to determine preliminary eligibility for consent. Among borderline cases, eligible patients will be included if there is a reasonable expectation of the need for surgery or cardiac catheterization during the birth hospitalization.]

  2. Singleton gestation.
  3. Gestational age at randomization for impending deliveries between 37 0/7 - 41 6/7 weeks of gestation inclusive based on clinical information and evaluation of the earliest ultrasound determined using criteria proposed by the American Congress of Obstetricians and Gynecologists (ACOG), the American Institute of Ultrasound in Medicine and the Society for Maternal-Fetal Medicine.

    [NOTE: Pregnant individuals who were admitted to the delivery hospital prior to 37 0/7 weeks of gestation remain eligible to randomize, provided they deliver within the 37 0/7 and 41 6/7 weeks "eligibility window". Alternatively, if an eligible dyad is randomized at or just prior to 41 6/7 weeks, they remain in trial.]

  4. Consent for the participant and their infant

Exclusion criteria are listed below and will be confirmed prior to randomization:

Exclusion Criteria for Pregnant Individuals:

  1. Pregnant individual is a gestational carrier or surrogate.
  2. Compromise of the pregnant individual (e.g., vasa previa, placental accreta with hypotension, placental abruption, amniotic fluid embolism, uterine rupture, uterine inversion, disseminated intravascular coagulation), as determined by local care team

[NOTE: There is no limitation on pregnant individual's age]

Fetal Exclusion Criteria:

  1. Fetal demise or planned termination of pregnancy prior to randomization
  2. Tachyarrhythmia requiring transplacental therapy
  3. Fetal hydrops, severe
  4. Planned fetal surgery
  5. Diaphragmatic hernia, omphalocele, gastroschisis, intestinal atresia
  6. Major chromosomal defects (e.g., Trisomy 13, 18) identified prenatally; Trisomy 21 is allowed
  7. Disease or disorder impacting candidacy for neonatal cardiac interventions
  8. Parents choosing to limit treatment

Pregnancy Exclusion Criteria:

  1. Delivery planned at an institution not affiliated with or does not refer to a CORD-CHD participating site
  2. Participation in another prenatal interventional study that influences cord clamping or perinatal morbidity or mortality

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: Supportive Care
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: Delayed Cord Clamping at 30 Seconds (DCC-30)
The umbilical cord will be clamped between 1 - <60 seconds following delivery, with a goal of around 30 seconds.
Care team will wait to clamp the umbilical between 1-<60 seconds after birth. 30 seconds is the ideal time of clamping.
Other Names:
  • Randomized to DCC-30 Group
Active Comparator: Delayed Cord Clamping at 120 Seconds (DCC-120)

The umbilical cord will be clamped at 60 - 180- seconds following delivery, with a goal of around 120 seconds.

In the DCC-120 group, if there is concern for pregnant individual or baby and their doctor is not able to wait until at least 60 seconds, the doctor may do cord milking, which is four gentle squeezes of the umbilical cord pushing blood from the placenta to baby.

Care team will wait to clamp the umbilical cord between 60-180 seconds after birth.120 seconds is the ideal time of clamping
Other Names:
  • Randomized to DCC-120 Group

For infants who need their cord clamped before the target in the DCC-120 group. Care team may milk the umbilical cord towards the infant four times. Cord milking should NOT be performed if the delay meets or exceeds 60 seconds.

Umbilical cord milking will not be provided among participant-infant dyads in the DCC-30 group.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Global Rank Score (Infant participant)
Time Frame: Up to 30 days post-discharge following congenital heart disease intervention
Mortality=97;Heart transplant=96;Complication preventing cardiac intervention=95;Pre or Post-intervention neurologic complication=95;Pre or Post-intervention respiratory failure w/tracheostomy=95;Renal failure permanent dialysis=95;Unplanned cardiac surgery after initial cardiac intervention=94;Cardiac arrest=94;Pre or Post-intervention multisystem organ failure=94;Mechanical circulatory support=94;Pre-intervention polycythemia w/exchange transfusion/hemodilution=93;Unplanned cardiac catheterization after initial cardiac intervention=93;Pre-intervention mechanical ventilation=93;Pre-intervention necrotizing enterocolitis(Bell's II/III)=93;Pre-intervention shock=93;Pre-intervention unplanned hospitalization=93;Post-intervention bleeding reoperation=93;Delayed sternal closure=93;Pre-intervention renal failure temporary dialysis=93;Post-intervention renal failure, temporary dialysis=92;Post-intervention mechanical ventilation >7 days=92;Hospital length of stay >90 days=91,1-90 days=1-90
Up to 30 days post-discharge following congenital heart disease intervention

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Neuromotor Outcomes at 3-4 months of age (Infant participant)
Time Frame: 3-4 months after birth
General Movements Assessment (GMA): The General Movements Assessment is used to identify absent or abnormal general movements in infants. General movements are spontaneous movements exhibited during fetal development and through the first 6 months of life after birth. Trained investigators will evaluate the infants general movements as: 1) Fidgety present; 2) Fidgety abnormal; and 3) Absent fidgety where "Fidgety present" is considered normal, and the other two outcomes are considered abnormal.
3-4 months after birth
Impact of infant's congenital heart disease (Parents / Caregivers)
Time Frame: 3-4 months after birth
Questionnaire/Survey on the impact of infant's congenital heart disease upon the family dynamic; Impact on Family Scale - Revised: The Impact on Family Scale - Revised is a questionnaire for parents / caregivers used to evaluate perceptions of the impact of an infant's chronic medical condition (e.g., congenital heart disease) upon the family. The IFS-R uses a 4-point Likert-type scale (strongly agree to strongly disagree) for responses. High scores correlate with parental / caregiver stressors and psychiatric symptoms, poor infant health, and increased pediatric hospitalizations and/or health maintenance requirement, representing worse outcomes.
3-4 months after birth
Impact of infant's congenital heart disease (Parents / Caregivers)
Time Frame: 3-4 months after birth
Questionnaire/Survey on the impact of infant's congenital heart disease upon the family dynamic; Functional Status II - Revised, Short Form: The Functional Status II - Revised, Short Form will be used to evaluate the functional status of infants that have been diagnosed with and undergone treatment for congenital heart disease. This survey, completed by parents / caregivers, is used to evaluate a core of 14 items using a 3-point Likert scale. The respondent (parent / caregiver) first rates the extent of difficulty with specific behaviors that the infant experiences, and then rates for those behaviors with difficulty, the extent to which the difficulty is due to the infants chronic illness. Higher scores generally indicate a reduced burden of chronic heart disease impacting the family, and therefore, a better outcome.
3-4 months after birth
Impact of infant's congenital heart disease (Parents / Caregivers)
Time Frame: 9-12 months after birth
Questionnaire/Survey on the impact of infant's congenital heart disease upon the family dynamic; Impact on Family Scale - Revised: The Impact on Family Scale - Revised is a questionnaire for parents / caregivers used to evaluate perceptions of the impact of an infant's chronic medical condition (e.g., congenital heart disease) upon the family. The IFS-R uses a 4-point Likert-type scale (strongly agree to strongly disagree) for responses. High scores correlate with parental / caregiver stressors and psychiatric symptoms, poor infant health, and increased pediatric hospitalizations and/or health maintenance requirement, representing worse outcomes.
9-12 months after birth
Impact of infant's congenital heart disease (Parents / Caregivers)
Time Frame: 9-12 months after birth
Questionnaire/Survey on the impact of infant's congenital heart disease upon the family dynamic; Functional Status II - Revised, Short Form: The Functional Status II - Revised, Short Form will be used to evaluate the functional status of infants that have been diagnosed with and undergone treatment for congenital heart disease. This survey, completed by parents / caregivers, is used to evaluate a core of 14 items using a 3-point Likert scale. The respondent (parent) first rates the extent of difficulty with specific behaviors that the infant experiences, and then rates for those behaviors with difficulty, the extent to which the difficulty is due to the infants chronic illness. Higher scores generally indicate a reduced burden of chronic heart disease impacting the family, and therefore, a better outcome.
9-12 months after birth
Impact of infant's congenital heart disease (Parents / Caregivers)
Time Frame: 22-26 months after birth
Questionnaire/Survey on the impact of infant's congenital heart disease upon the family dynamic; Impact on Family Scale - Revised: The Impact on Family Scale - Revised is a questionnaire for parents / caregivers used to evaluate perceptions of the impact of an infant's chronic medical condition (e.g., congenital heart disease) upon the family. The IFS-R uses a 4-point Likert-type scale (strongly agree to strongly disagree) for responses. High scores correlate with parental / caregiver stressors and psychiatric symptoms, poor infant health, and increased pediatric hospitalizations and/or health maintenance requirement, representing worse outcomes.
22-26 months after birth
Impact of infant's congenital heart disease (Parents / Caregivers)
Time Frame: 22-26 months after birth
Questionnaire/Survey on the impact of infant's congenital heart disease upon the family dynamic; Functional Status II - Revised, Short Form: The Functional Status II - Revised, Short Form will be used to evaluate the functional status of infants that have been diagnosed with and undergone treatment for congenital heart disease. This survey, completed by parents / caregivers, is used to evaluate a core of 14 items using a 3-point Likert scale. The respondent (parent) first rates the extent of difficulty with specific behaviors that the infant experiences, and then rates for those behaviors with difficulty, the extent to which the difficulty is due to the infants chronic illness. Higher scores generally indicate a reduced burden of chronic heart disease impacting the family, and therefore, a better outcome.
22-26 months after birth
Neurodevelopmental Outcomes at 22-26 months (Infant participant)
Time Frame: 22-26 months after birth
Hammersmith Infant Neurological Exam (HINE): The Hammersmith Infant Neurological Examination (HINE) consists of 26 items that assess different aspects of infant neurological function. The maximal global (total) score is 78, divided among the following domains: cranial nerve function (maximum score 15); posture (maximum score 18); movements (maximum score 6); muscle tone (maximum score 24) and reflexes and reactions (maximum score 15). Higher scores indicate better expected outcomes.
22-26 months after birth
Neurodevelopmental Outcomes at 22-26 months (Infant participant)
Time Frame: 22-26 months after birth
Developmental Assessment of Young Children, 2nd Edition (DAYC-2): The Developmental Assessment of Young Children, Second Edition (DAYC-2) is used to evaluate infants and children over 5 domains: cognition; communication; social-emotional development; physical development; and adaptive behavior. The DAYC-2 uses a norm-referenced sample to establish standardized scores in each domain, allowing investigators to compare the results to infants of similar age. Percentile ranks, and age equivalents are provided for each domain. Elements are graded on a simple "Yes" or "No" scale, with "Yes" being 1 point and "No" being 0 points. In general, higher scores reflect better expected outcomes.
22-26 months after birth
Parental perspectives of outcomes (Parents / Caregivers)
Time Frame: 22-26 months after birth
Survey of parent / caregiver opinions of expectations and outcomes as it relates to their infant with congenital heart disease. This questionnaire will examine parental perspectives with regards to health and neurodevelopmental outcomes, as compared to those commonly used in pediatric medicine. For example, parents / caregivers may place greater emphasis upon their child being able to conduct physical activity as compared to how well they perform tasks (fine and gross neuromotor function). Additionally, parents may express concern for their infant being able to eat without requiring a feeding tube, or breathing without the need for assistance or additional oxygen support. The survey will also seek to determine areas in which parents / caregivers feel there is room for improvement as it applies to their infant. There is no formal "scale" for this survey, as responses are primarily open-ended, requiring descriptive content analysis.
22-26 months after birth
Delivery Complications and Outcomes (Pregnant individual participant)
Time Frame: Through hospital discharge (up to 1 month)
Incidence of postpartum hemorrhage (defined as blood loss >1L within 24 hours post-delivery)
Through hospital discharge (up to 1 month)
Delivery Complications and Outcomes (Pregnant individual participant)
Time Frame: Through hospital discharge (up to 1 month)
Incidence of prolonged 3rd stage of labor (defined as retention of placenta for >30 minutes postpartum)
Through hospital discharge (up to 1 month)
Delivery Complications and Outcomes (Pregnant individual participant)
Time Frame: Through hospital discharge (up to 1 month)
Incidence of requirement for uterine balloon tamponade or other surgical intervention to treat postpartum hemorrhage
Through hospital discharge (up to 1 month)
Delivery Complications and Outcomes (Pregnant individual participant)
Time Frame: Through hospital discharge (up to 1 month)
Incidence of requirements for manual placental removal
Through hospital discharge (up to 1 month)
Delivery Complications and Outcomes (Pregnant individual participant)
Time Frame: Through hospital discharge (up to 1 month)
Incidence of requirement for transfusion, post-partum
Through hospital discharge (up to 1 month)
Delivery Complications and Outcomes (Pregnant individual participant)
Time Frame: Through hospital discharge (up to 1 month)
Volume of transfusion required, if applicable
Through hospital discharge (up to 1 month)
Delivery Complications and Outcomes (Pregnant individual participant)
Time Frame: Through hospital discharge (up to 1 month)
Type of transfusion required (e.g., whole blood, red blood cells, platelets, etc.), if applicable
Through hospital discharge (up to 1 month)
Delivery Complications and Outcomes (Pregnant individual participant)
Time Frame: Through hospital discharge (up to 1 month)
Incidence of postpartum endometritis
Through hospital discharge (up to 1 month)
Delivery Complications and Outcomes (Pregnant individual participant)
Time Frame: Through hospital discharge (up to 1 month)
Incidence of mortality
Through hospital discharge (up to 1 month)
Delivery Complications and Outcomes (Pregnant individual participant)
Time Frame: Through hospital discharge (up to 1 month)
Incidence of use of medications for postpartum hemorrhage management other than oxytocin (e.g., methergine, tranexamic acid, hemabate, misoprostol)
Through hospital discharge (up to 1 month)

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Investigators

  • Principal Investigator: Anup Katheria, MD, Sharp Mary Birch Hospital for Women & Newborns
  • Principal Investigator: Carl Backes, MD, Nationwide Children's Hospital
  • Principal Investigator: Kevin Hill, MD, Duke Children's Hospital
  • Principal Investigator: Madeline Rice, PhD, George Washington University Biostatistics Center
  • Principal Investigator: Grecio (Greg) Sandoval, PhD, George Washington University Biostatistics Center
  • Principal Investigator: Scott Evans, PhD, George Washington University Biostatistics Center

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 (Actual)

December 19, 2023

Primary Completion (Estimated)

October 1, 2028

Study Completion (Estimated)

December 1, 2030

Study Registration Dates

First Submitted

November 12, 2023

First Submitted That Met QC Criteria

November 22, 2023

First Posted (Actual)

December 1, 2023

Study Record Updates

Last Update Posted (Actual)

August 5, 2025

Last Update Submitted That Met QC Criteria

July 31, 2025

Last Verified

July 1, 2025

More Information

Terms related to this study

Other Study ID Numbers

  • STUDY00003337
  • UG3HL166794 (U.S. NIH Grant/Contract)
  • UG3HL166799 (Other Grant/Funding Number: NHLBI)

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

YES

IPD Plan Description

Data will be made available per NIH/NHLBI requirements (National Heart, Lung, and Blood Institute)

IPD Sharing Time Frame

2 years after primary publication

IPD Sharing Access Criteria

An archived dataset with documentation will be made available for additional uses by outside investigators, in collaboration with the study investigators. We will work with NIH/NHLBI program staff to develop a broad data sharing plan over time.

IPD Sharing Supporting Information Type

  • SAP

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

product manufactured in and exported from the U.S.

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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