Rechercher
image du produit
American Journal of Obstetrics and Gynecology

S'abonner

Delayed cord clamping in small for gestational age preterm infants - 26/01/22

Doi : 10.1016/j.ajog.2021.08.003 
Beth Ellen Brown, MD a, ⁎ , Prakesh S. Shah, MD b, c, Jehier K. Afifi, MD a, Rebecca L. Sherlock, MD d, Mohammad A. Adie, MD e, Luis A. Monterrosa, MD f, Joan M. Crane, MD g, Xiang Y. Ye, MSc b, Walid I. El-Naggar, MD a
On behalf of the

Canadian Neonatal Network

 P.S.S., MD, MSc, Marc Beltempo, MD, Jaideep Kanungo, MD, Joseph Ting, MD, Zenon Cieslak, MD, Rebecca Sherlock, MD, Ayman Abou Mehrem, MD, Jennifer Toye, MD, Khalid Aziz, MBBS, Jaya Bodani, MD, Lannae Strueby, MD, Mary Seshia, MbChB, Deepak Louis, MD, Ruben Alvaro, MD, Amit Mukerji, MD, Orlando da Silva, MD, MSc, Sajit Augustine, MD, Kyong-Soon Lee, MD, MSc, Eugene Ng, MD, Brigitte Lemyre, MD, Thierry Daboval, MD, Faiza Khurshid, MD, Victoria Bizgu, MD, Keith Barrington, MbChB, Anie Lapoint, MD, Guillaume Ethier, NNP, Christine Drolet, MD, Bruno Piedboeuf, MD, Martine Claveau, MSc, LLM, NNP, Marie St-Hilaire, MD, Valerie Bertelle, MD, Edith Masse, MD, Roderick Canning, MD, Hala Makary, MD, Cecil Ojah, MBBS, Luis Monterrosa, MD, Julie Emberley, MD, Jehier Afifi, MB BCh, MSc, Andrzej Kajetanowicz, MD, Shoo K. Lee, MBBS, PhD

and the

Canadian Preterm Birth Network Investigators

Wendy Whittle, MD, Michelle Morais, MD, Leanne Dahlgren, MD, Darine El-Chaar, MD, Katherine Theriault, MD, Annie Ouellet, MD, Kimberly Butt, MD, Stephen Wood, MD, Amy Metcalfe, PhD, Candace O’Quinn, MD, Christy Pylypjuk, MD, Isabelle Boucoiran, MSc, MD, Catherine Taillefer, MD, Joan Crane, MD, Haim Abenhaim, MD, Graeme Smith, MD, Karen Wou, MDCM, Sue Chandra, MD, Jagdeep Ubhi, MD, George Carson, MD, Michael Helewa, MD, Ariadna Grigoriu, MD, Rob Gratton, MD, Cynthia Chan, MD, James Andrews, MD, Nir Melamed, MD, Jason Burrows, MD, Fatima Taboun, MD, Lara Wesson, MD, Erin MacLellan, MD, Hayley Boss, MD, Vicky Allen, MD

a Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada 
b Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada 
c Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada 
d Department of Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada 
e Department of Pediatrics, Windsor Regional Hospital, Windsor, Ontario, Canada 
f Department of Pediatrics, Saint John Regional Hospital, Horizon Health Network, Saint John, New Brunswick, Canada 
g Department of Obstetrics and Gynecology, Memorial University of Newfoundland and Labrador, St. John’s, Newfoundland, Canada 

∗Corresponding author: Beth Ellen Brown, MD.

Abstract

Background

Infants with restricted growth for age are frequently exposed to insufficient placental circulation and are more likely to develop postnatal complications. Delayed cord clamping at birth for these infants requires further exploration.

Objective

This study aimed to compare the short-term neonatal outcomes of delayed cord clamping with that of early cord clamping in small for gestational age preterm infants and to explore whether the effects of delayed cord clamping in small for gestational age preterm infants are different from that in non–small for gestational age preterm infants.

Study Design

We conducted a national retrospective cohort study, including infants born at <33 weeks’ gestation and admitted to the Canadian Neonatal Network units between January 2015 and December 2017. Small for gestational age infants (birthweight of <10th percentile for gestational age and sex) who received delayed cord clamping ≥30 seconds were compared with those who received early cord clamping. In addition, non–small for gestational age infants who received delayed cord clamping were compared with those who received early cord clamping. The main study outcomes included composite outcome of mortality or major morbidity, neonatal morbidity rate, mortality rate, peak serum bilirubin, and number of blood transfusions. Multivariable logistic and linear regression models with a generalized estimation equation approach were used to account for the clustering of infants within centers.

Results

Overall, 9722 infants met the inclusion criteria. Of those infants, 1027 (10.6%) were small for gestational age. The median (interquartile range) gestational age was 31 weeks (range, 28–32 weeks). After adjusting for potential confounders, delayed cord clamping in small for gestational age infants was associated with a reduction in the composite outcome of mortality or major morbidity (adjusted odds ratio, 0.60; 95% confidence interval, 0.42–0.86) compared with early cord clamping. There was no difference between the 2 groups in peak serum bilirubin. Many associated benefits of delayed cord clamping in small for gestational age infants were similar to those in non–small for gestational age infants.

Conclusion

Delayed cord clamping in small for gestational age preterm infants was associated with decreased odds of mortality or major morbidity. Many of the benefits of delayed cord clamping in the small for gestational age preterm infants were similar to those identified in the non–small for gestational age preterm infants.

Le texte complet de cet article est disponible en PDF.

Key words : blood transfusion, early cord clamping, hyperbilirubinemia, infant, intrauterine growth restriction, morbidity, mortality, peak serum bilirubin, placental transfusion, temperature


Plan


 Present address: Beth Ellen Brown, MD. Department of Pediatrics, Queen Elizabeth Hospital, 60 Riverside Drive, Charlottetown, Prince Edward Island, C1A 8T5, Canada.
 The authors report no conflict of interest.
 This project was conducted with no specific financial support. Organizational support for the Canadian Neonatal Network and the Canadian Preterm Birth Network was provided by the Maternal-Infant Care (MiCare) Research Centre at Mount Sinai Hospital in Toronto, Ontario, Canada. MiCare is supported by a Canadian Institutes of Health Research (CIHR) Team Grant (grant number CTP 87518), the Ontario Ministry of Health and Long-Term Care, and the participating hospitals. P.S.S. held a CIHR Applied Research Chair in Reproductive and Child Health Services and Policy Research (APR-126340).
 The funders had no role in the study design; collection, analysis, or interpretation of data; writing of the report; or 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 data in the study and can take responsibility for the integrity of the data and the accuracy of the analysis.
 Cite this article as: Brown BE, Shah PS, Afifi JK, et al. Delayed cord clamping in small for gestational age preterm infants. Am J Obstet Gynecol 2022;226:247.e1-10.


Crown Copyright © 2021  Publié par Elsevier Masson SAS. Tous droits réservés.
Ajouter à ma bibliothèque Retirer de ma bibliothèque Imprimer
Export

    Export citations

  • Fichier

    •

  • Contenu

    •

Vol 226 - N° 2

P. 247.e1-247.e10 - février 2022 Retour au numéro
Article précédent Article précédent
  • Urologic morbidity associated with placenta accreta spectrum surgeries: single-center experience with a multidisciplinary team
  • Hadi Erfani, Bahram Salmanian, Karin A. Fox, Michael Coburn, Nazlisadat Meshinchiasl, Amir A. Shamshirsaz, Rachel Kopkin, Soumya Gogia, Kunal Patel, Josef Jackson, Max Cadena, Soroush Aalipour, Shyamsunder Sukumar, Ahmed A. Nassr, Jimmy Espinoza, Steven L. Clark, Michael A. Belfort, Alireza A. Shamshirsaz
| Article suivant Article suivant
  • The selective progesterone receptor modulator-promegestone-delays term parturition and prevents systemic inflammation-mediated preterm birth in mice
  • Oksana Shynlova, Lubna Nadeem, Anna Dorogin, Sam Mesiano, Stephen J. Lye

Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.

Déjà abonné à cette revue ?

Elsevier s'engage à rendre ses eBooks accessibles et à se conformer aux lois applicables. Compte tenu de notre vaste bibliothèque de titres, il existe des cas où rendre un livre électronique entièrement accessible présente des défis uniques et l'inclusion de fonctionnalités complètes pourrait transformer sa nature au point de ne plus servir son objectif principal ou d'entraîner un fardeau disproportionné pour l'éditeur. Par conséquent, l'accessibilité de cet eBook peut être limitée. Voir plus

Accès rapides

Mon compte

Aide & support

Plateformes Elsevier Masson

Déclaration CNIL

EM-CONSULTE.COM est déclaré à la CNIL, déclaration n° 1286925.

En application de la loi nº78-17 du 6 janvier 1978 relative à l'informatique, aux fichiers et aux libertés, vous disposez des droits d'opposition (art.26 de la loi), d'accès (art.34 à 38 de la loi), et de rectification (art.36 de la loi) des données vous concernant. Ainsi, vous pouvez exiger que soient rectifiées, complétées, clarifiées, mises à jour ou effacées les informations vous concernant qui sont inexactes, incomplètes, équivoques, périmées ou dont la collecte ou l'utilisation ou la conservation est interdite.
Les informations personnelles concernant les visiteurs de notre site, y compris leur identité, sont confidentielles.
Le responsable du site s'engage sur l'honneur à respecter les conditions légales de confidentialité applicables en France et à ne pas divulguer ces informations à des tiers.

Tout le contenu de ce site: Copyright © 2026 Elsevier, ses concédants de licence et ses contributeurs. Tout les droits sont réservés, y compris ceux relatifs à l'exploration de textes et de données, a la formation en IA et aux technologies similaires. Pour tout contenu en libre accès, les conditions de licence Creative Commons s'appliquent.