Early versus delayed umbilical cord clamping in infants with congenital heart disease: a pilot, randomized, controlled trial

C H Backes, H Huang, C L Cua, V Garg, C V Smith, H Yin, M Galantowicz, J A Bauer, T M Hoffman, C H Backes, H Huang, C L Cua, V Garg, C V Smith, H Yin, M Galantowicz, J A Bauer, T M Hoffman

Abstract

Objective: Delayed umbilical cord clamping (DCC) at birth may provide a better neonatal health status than early umbilical cord clamping (ECC). However, the safety and feasibility of DCC in infants with congenital heart disease (CHD) have not been tested. This was a pilot, randomized, controlled trial to establish the safety and feasibility of DCC in neonates with CHD.

Study design: Pregnant women admitted >37 weeks gestational age with prenatal diagnosis of critical CHD were enrolled and randomized to ECC or DCC. For ECC, the umbilical cord was clamped <10 s after birth; for DCC, the cord was clamped ~120 s after delivery.

Results: Thirty infants were randomized at birth. No differences between the DCC and ECC groups were observed in gestational age at birth or time of surgery. No differences were observed across all safety measures, although a trend for higher peak serum bilirubin levels (9.2±2.2 vs 7.3±3.2 mg dl(-1), P=0.08) in the DCC group than in the ECC group was noted. Although similar at later time points, hematocrits were higher in the DCC than in the ECC infants during the first 72 h of life. The proportion of infants not receiving blood transfusions throughout hospitalization was higher in the DCC than in the ECC infants (43 vs 7%, log-rank test P=0.02).

Conclusion: DCC in infants with critical CHD appears both safe and feasible, with fewer infants exposed to red blood cell transfusions than with ECC. A more comprehensive appraisal of this practice is warranted.

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Flow diagram for patient selection, inclusion and exclusion from the study.
Figure 2
Figure 2
The course of hematocrit concentrations throughout hospitalization for infants in the delayed umbilical cord clamping and early umbilical cord clamping groups. Data are means ± s.e.m. *P < 0.05. CPB, cardiopulmonary bypass; DCC, delayed umbilical cord clamping; ECC, early umbilical cord clamping; Pre-Op, pre-operative; Post-Op, post-operative.
Figure 3
Figure 3
Kaplan–Meier curves of the probability of being free from a blood transfusion in the delayed umbilical cord clamping group and the early umbilical cord clamping group. Statistically different by log-rank test (P = 0.02). DCC, delayed umbilical cord clamping; ECC, early umbilical cord clamping.

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