Résumé
Objective: To evaluate the rates of practice, and the associations between different cord management strategies at birth (delayed cord clamping [DCC], umbilical cord milking [UCM], and early cord clamping [ECC]) and mortality or major morbidity, rates of blood transfusion, and peak serum bilirubin in a large national cohort of very preterm infants. Study design: We retrospectively studied preterm infants <33 weeks of gestation admitted to the Canadian Neonatal Network between January 2015 and December 2017. Patients who received ECC (<30 seconds), UCM, or DCC (≥30 seconds) were compared. Multiple generalized linear/quantile logistic regression models were used. Results: Of 12 749 admitted infants, 9729 were included; 4916 (50.5%) received ECC, 394 (4.1%) UCM, and 4419 (45.4%) DCC. After adjustment for potential confounders identified between groups in univariate analyses, the odds of mortality or major morbidity were higher in the ECC group when compared with UCM group (aOR, 1.18; 95% CI, 1.03-1.35). Mortality and intraventricular hemorrhage were associated with ECC as compared with DCC (aOR, 1.6 [95% CI, 1.22-2.1] and aOR, 1.29 [95% CI, 1.19-1.41], respectively). The odds of severe intraventricular hemorrhage were higher with UCM compared with DCC (aOR, 1.38; 95% CI, 1.05-1.81). Rates of blood transfusion were higher with ECC compared with UCM and DCC (aOR, 1.67 [95% CI, 1.31-2.14] and aOR, 1.68 [95% CI, 1.35-2.09], respectively), although peak serum bilirubin levels were not significantly different. Conclusions: Both DCC and UCM were associated with better short-term outcomes than ECC; however, the odds of severe intraventricular hemorrhage were higher with UCM compared with DCC.
| Langue d'origine | English |
|---|---|
| Pages (de-à) | 58-64.e4 |
| Journal | Journal of Pediatrics |
| Volume | 225 |
| DOI | |
| Statut de publication | Published - oct. 2020 |
Note bibliographique
Funding Information:Organizational support for the Canadian Neonatal Network and the Canadian Preterm Birth Network was provided by the Maternal-infant Care Research Centre (MiCare) at Mount Sinai Hospital in Toronto, Ontario, Canada. MiCare is supported by a Canadian Institutes of Health Research (CIHR) Team Grant ( CTP 87518 ), the Ontario Ministry of Health and Long-Term Care , and the participating hospitals. PSS holds a CIHR Applied Research Chair in Reproductive and Child Health Services and Policy Research (APR-126340). The funders had no roles in the study design; the collection, analysis, or interpretation of data; the writing of the report; or the decision to submit the article for publication. We confirm the independence of the study researchers from the funders; and we confirm that all authors, external and internal, had full access to all the data in the study and can take responsibility for the integrity of the data and the accuracy of the analysis. The authors declare no conflicts of interest.
Funding Information:
We thank all site investigators and data abstractors of the Canadian Neonatal Network (CNN) and the Canadian Preterm Birth Network (CPTBN). We thank Heather McDonald Kinkaid, PhD, from the Maternal-infant Care Research Centre (MiCare) at Mount Sinai Hospital in Toronto, Ontario, for editorial support in the preparation of this manuscript; and other MiCare staff for organizational support of CNN and CPTBN. MiCare is supported by funding from the Canadian Institutes of Health Research, the Ontario Ministry of Health and Long-Term Care, and the participating hospitals.Organizational support for the Canadian Neonatal Network and the Canadian Preterm Birth Network was provided by the Maternal-infant Care Research Centre (MiCare) at Mount Sinai Hospital in Toronto, Ontario, Canada. MiCare is supported by a Canadian Institutes of Health Research (CIHR) Team Grant (CTP 87518), the Ontario Ministry of Health and Long-Term Care, and the participating hospitals. PSS holds a CIHR Applied Research Chair in Reproductive and Child Health Services and Policy Research (APR-126340). The funders had no roles in the study design; the collection, analysis, or interpretation of data; the writing of the report; or the decision to submit the article for publication. We confirm the independence of the study researchers from the funders; and we confirm that all authors, external and internal, had full access to all the data in the study and can take responsibility for the integrity of the data and the accuracy of the analysis. The authors declare no conflicts of interest. Funding and disclosure information is available at www.jpeds.com.
Funding Information:
We thank all site investigators and data abstractors of the Canadian Neonatal Network (CNN) and the Canadian Preterm Birth Network (CPTBN). We thank Heather McDonald Kinkaid, PhD, from the Maternal-infant Care Research Centre (MiCare) at Mount Sinai Hospital in Toronto, Ontario, for editorial support in the preparation of this manuscript; and other MiCare staff for organizational support of CNN and CPTBN. MiCare is supported by funding from the Canadian Institutes of Health Research , the Ontario Ministry of Health and Long-Term Care , and the participating hospitals.
Publisher Copyright:
© 2020 Elsevier Inc.
ASJC Scopus Subject Areas
- Pediatrics, Perinatology, and Child Health
PubMed: MeSH publication types
- Comparative Study
- Journal Article
- Research Support, Non-U.S. Gov't