title: Effects of Placental Transfusion on Neonatal and 18 Month Outcomes in Preterm Infants: A Randomized Controlled Trial.
abstract: OBJECTIVE
  To assess the effect of delayed cord clamping (DCC) vs immediate cord clamping (ICC) on intraventricular hemorrhage (IVH), late onset sepsis (LOS), and 18-month motor outcomes in preterm infants.
  
  
  METHODS
  Women (n = 208) in labor with singleton fetuses (<32 weeks gestation) were randomized to either DCC (30-45 seconds) or ICC (<10 seconds). The primary outcomes were IVH, LOS, and motor outcomes at 18-22 months corrected age. Intention-to-treat was used for primary analyses.
  
  
  RESULTS
  Cord clamping time was 32 ± 16 (DCC) vs 6.6 ± 6 (ICC) seconds. Infants in the DCC and ICC groups weighed 1203 ± 352 and 1136 ± 350 g and mean gestational age was 28.3 ± 2 and 28.4 ± 2 weeks, respectively. There were no differences in rates of IVH or LOS between groups. At 18-22 months, DCC was protective against motor scores below 85 on the Bayley Scales of Infant Development, Third Edition (OR 0.32, 95% CI 0.10-0.90, P = .03). There were more women with preeclampsia in the ICC group (37% vs 22%, P = .02) and more women in the DCC group with premature rupture of membranes/preterm labor (54% vs 75%, P = .002). Preeclampsia halved the risk of IVH (OR 0.50, 95% CI 0.2-1.0) and premature rupture of membranes/preterm labor doubled the risk of IVH (OR 2.0, 95% CI 1.2-4.3).
  
  
  CONCLUSIONS
  Although DCC did not alter the incidence of IVH or LOS in preterm infants, it improved motor function at 18-22 months corrected age.
  
  
  BACKGROUND
  ClinicalTrials.gov: NCT00818220 and NCT01426698.
authors.affiliation: University of Rhode Island, Kingston, RI; Alpert School of Medicine, Brown University, Providence, RI; Women and Infants Hospital of Rhode Island, Providence, RI.
authors.forename: Judith S
authors.initials: JS
authors.lastname: Mercer
authors.affiliation: University of Rhode Island, Kingston, RI; Alpert School of Medicine, Brown University, Providence, RI; Women and Infants Hospital of Rhode Island, Providence, RI.
authors.forename: Debra A
authors.initials: DA
authors.lastname: Erickson-Owens
authors.affiliation: Alpert School of Medicine, Brown University, Providence, RI; Women and Infants Hospital of Rhode Island, Providence, RI.
authors.forename: Betty R
authors.initials: BR
authors.lastname: Vohr
authors.affiliation: Women and Infants Hospital of Rhode Island, Providence, RI.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Tucker
authors.affiliation: Women and Infants Hospital of Rhode Island, Providence, RI.
authors.forename: Ashley B
authors.initials: AB
authors.lastname: Parker
authors.affiliation: Alpert School of Medicine, Brown University, Providence, RI; Women and Infants Hospital of Rhode Island, Providence, RI.
authors.forename: William
authors.initials: W
authors.lastname: Oh
authors.affiliation: Alpert School of Medicine, Brown University, Providence, RI; Women and Infants Hospital of Rhode Island, Providence, RI.
authors.forename: James F
authors.initials: JF
authors.lastname: Padbury
mesh_terms: D000328:Adult; D001803:Blood Transfusion / Q000379:methods*; D002543:Cerebral Hemorrhage / Q000453:epidemiology / Q000209:etiology*; D003250:Constriction; D036861:Delivery, Obstetric; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D057194:Intention to Treat Analysis; D008297:Male; D010920:Placenta; D011247:Pregnancy; D011446:Prospective Studies; D018805:Sepsis / Q000453:epidemiology / Q000209:etiology*; D065227:Transfusion Reaction; D014470:Umbilical Cord / Q000098:blood supply*