title: Delayed umbilical cord clamping in premature neonates.
abstract: OBJECTIVE
  Delayed umbilical cord clamping is reported to increase neonatal blood volume. We estimated the clinical outcomes in premature neonates who had delayed umbilical cord clamping compared with a similar group who had early umbilical cord clamping.
  
  
  METHODS
  This was a before-after investigation comparing early umbilical cord clamping with delayed umbilical cord clamping (45 seconds) in two groups of singleton neonates, very low birth weight (VLBW) (401-1,500 g) and low birth weight (LBW) (greater than 1,500 g but less than 35 weeks gestation). Neonates were excluded from delayed umbilical cord clamping if they needed immediate major resuscitation. Primary outcomes were provision of delivery room resuscitation, hematocrit, red cell transfusions, and the principle Vermont Oxford Network outcomes.
  
  
  RESULTS
  In VLBW neonates (77 delayed umbilical cord clamping, birth weight [mean±standard deviation] 1,099±266 g; 77 early umbilical cord clamping 1,058±289 g), delayed umbilical cord clamping was associated with less delivery room resuscitation, higher Apgar scores at 1 minute, and higher hematocrit. Delayed umbilical cord clamping was not associated with significant differences in the overall transfusion rate, peak bilirubin, any of the principle Vermont Oxford Network outcomes, or mortality. In LBW neonates (172 delayed umbilical cord clamping, birth weight [mean±standard deviation] 2,159±384 g; 172 early umbilical cord clamping 2,203±447 g), delayed umbilical cord clamping was associated with higher hematocrit and was not associated with a change in delivery room resuscitation or Apgar scores or with changes in the transfusion rate or peak bilirubin. Regression analysis showed increasing gestational age and birth weight and delayed umbilical cord clamping were the best predictors of higher hematocrit and less delivery room resuscitation.
  
  
  CONCLUSIONS
  Delayed umbilical cord clamping can safely be performed in singleton premature neonates and is associated with a higher hematocrit, less delivery room resuscitation, and no significant changes in neonatal morbidities.
  
  
  METHODS
  II.
authors: Department of Neonatology, Providence St. Vincent Medical Center, Portland, Oregon 97225, USA. joe@nnspc.com
authors: Joseph W
authors: JW
authors: Kaempf
authors: Mark W
authors: MW
authors: Tomlinson
authors: Andrew J
authors: AJ
authors: Kaempf
authors: YingXing
authors: Y
authors: Wu
authors: Lian
authors: L
authors: Wang
authors: Nicole
authors: N
authors: Tipping
authors: Gary
authors: G
authors: Grunkemeier
mesh_terms: D005260:Female; D006400:Hematocrit; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000502:physiology*; D019102:Infant, Very Low Birth Weight / Q000502:physiology; D011247:Pregnancy; D012151:Resuscitation / Q000706:statistics & numerical data; D013997:Time Factors; D014470:Umbilical Cord