Abstract 14885: Delayed Umbilical Cord Clamping Among Infants With Congenital Heart Disease: A Randomized, Multi-Center, Controlled Trial
Introduction: Immediate umbilical cord clamping (ICC) at birth is routine practice but recent studies suggest that a delay in cord clamping (DCC) may improve neonatal health status including exposure to fewer blood transfusions and improvement in iron status. Infants born with congenital heart disease (CHD) are likely to receive peri-operative blood transfusions which may have deleterious effects. In this pilot trial we tested these hypotheses: 1) DCC can be safely implemented among infants with a prenatal diagnosis of CHD; 2) DCC improves blood volume status and is associated with a reduction in blood transfusions during the initial hospitalization.
Methods: Randomized, controlled, multi-center, pilot clinical trial. Pregnant women admitted >37 weeks gestational age (GA) with a prenatal diagnosis of CHD were enrolled and assigned to either ICC or DCC. For ICC, the umbilical cord was clamped immediately (<10 seconds) after birth; for DCC, the cord was clamped 120 seconds after delivery.
Results: 24 total infants were in the ICC or DCC groups (Figure 1). There were no differences in maternal demographics, birth weight, Apgar score, RACHS, Aristotle (Basic/Comprehensive Score), or perioperative inotropic scores. A similar number of single ventricle patients were seen in both groups (25 v 33%). The DCC group had higher hematocrit values on admission (59 v 52%, p=0.03) and 48 hours of life (54 v 48%, p=0.04).There was a non-significant trend toward fewer peri-operative blood transfusions in the DCC group relative to the ICC group (32 v 41 ml/kg, p=0.058). More infants in the DCC, compared to the ICC group, required phototherapy (25 v 8%, p <0.05). No infants required an exchange transfusion.
Conclusion: DCC can be safely implemented among infants born with CHD; higher perinatal hematocrit and a potential reduction in transfusion requirement may be related advantages. Further studies to define perioperative efficacy and mechanistic benefits are warranted.
- © 2013 by American Heart Association, Inc.