Delayed cord clamping(DCC) at 1 minute versus 3 minutes in preterm neonates: A randomised controlled trial

BACKGROUNDA newborn experiences a variety of unique challenges at birth.  Significant cardiovascular changes occur and this transition in hemodynamics from fetal to extrauterine life is a vital phase in the early days of life. An increase in the   amount of newborn hemoglobin (Hb) and blood volume achieved through placental transfusion has the potential to improve cardiac output and tissue oxygen delivery during this critical period. Placental transfusion therefore has recently gained much importance. It involves the transfer of left over placental blood to the newborn baby during the initial minutes of life. There are three techniques to achieve this: delayed cord clamping (DCC), intact umbilical cord milking (I-UCM), and cut umbilical cord milking (C-UCM). Different placental transfusion strategies has shown to have significant  and hematological benefits in this vital period and beyond.

Despite being recommended as a routine practice, there are  concerns about the potentially harmful effects of DCC on neonatal and maternal outcomes such as higher incidences of polycythemia, neonatal hyperbilirubinemia (NNH), and the need for phototherapy, and postpartum hemorrhage in mothers with low certainty of evidence. However the systematic reviews evaluating these risks had low certainty of evidence owing to different methodologies of individual studies .

Therefore, to decide a uniform timing for cord clamping, and thus establish the optimal definition of DCC, more evidence needs to be generated. There is biological plausibility that the extra blood transfused by extending the time of  DCC upto 3 minutes would result in improved hematological parameters  and better neonatal transition. Limited number of studies are available in near term and term infants but  there is paucity  of data in preterm infants.

PURPOSE OF THE STUDY

·       Despite the reported benefits of  DCC,  the literature is scanty regarding the timing of delayed cord clamping .

·       No consensus exists as of now on the optimal cord clamping timing while practising delayed cord clamping  and more so in preterm neonates.

 In view of lack of consensus regarding optimal timing of DCC and scarcity of similar data in preterm infants from low- and middle-income countries (LMICs). , this study is designed to compare DCC for 1 minute versus 3 minutes with regards to hematological and clinical hemodynamic parameters in preterm neonates of 30-37 weeks gestation.  We hypothesize that DCC for 3 minutes will lead to higher serum hematocrit at 48 hrs of age compared to DCC for 1 min  in neonates of 30-37 weeks gestation