Rechercher
image du produit
American Journal of Obstetrics and Gynecology

S'abonner

Umbilical cord management in extremely preterm infants born by cesarean delivery - 02/02/26

Doi : 10.1016/j.ajog.2025.09.036 
Haifaa Kashkari, MD a, b, Prakesh S. Shah, MD c, d, Jehier K. Afifi, MD a, Eugene Yoon, MSc d, Joan M. Crane, MD e, Sarah D. McDonald, MD f, Marc Beltempo, MD g, Walid I. El-Naggar, MD a, ⁎
On behalf of the

Canadian Neonatal Network

Marc Beltempo, MD, Prakesh S. Shah, MD, MSc, Thevanisha Pillay, MD, Jonathan Wong, MD, Miroslav Stavel, MD, Rebecca Sherlock, MD, Ayman Abou Mehrem, MD, Jennifer Toye, MD, Joseph Ting, MD, Carlos Fajardo, MD, Andrei Harabor, MD, Lannae Strueby, MD, Mary Seshia, MBChB, Deepak Louis, MD, Chelsea Ruth, MD, Ann Yi, MD, Amit Mukerji, MD, Kevin Coughlin, MD, MSc, Sajit Augustine, MD, Kyong-Soon Lee, MD, MSc, Eugene Ng, MD, Brigitte Lemyre, MD, Brigitte Lemyre, MD, Eyad Bitar, MD, Victoria Bizgu, MD, Nina Nouraeyan, MD, Keith Barrington, MBChB, Anie Lapointe, MD, Guillaume Ethier, NNP, Christine Drolet, MD, Marco Zeid, NNP, MSc (N), Marie St-Hilaire, MD, Valerie Bertelle, MD, Edith Masse, MD, Paloma Costa, MD, Hala Makary, MD, Ahmad Aziz, MD, Gabriela de Carvalho Nunes, MD, Wissam Alburaki, MD, Jo-Anna Hudson, MD, Jehier Afifi, MB BCh, MSc, Andrzej Kajetanowicz, MD, Catherine Chang, MD, Bruno Piedboeuf, MD

and the

Canadian Preterm Birth Network Investigators

Wendy Whittle, MD, Swati Agarwal, MD, Kenneth Lim, MD, Jessica Liauw, MHSc, MD, Darine El-Chaar, MD, KatherineHayley Boss, MD, Vicky Allen, MD,  Theriault, MD, MarieÈve Roy-Lacroix, MD, Kimberly Butt, MD, Candace O’Quinn, 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, Ernesto Figueiro-Filho, MD, Michael Helewa, MD, Ariadna Grigoriu, MD, Rob Gratton, MD, Cynthia Chan, MD, Gabriela de Caralho Nunes, MD, Ludmila Porto, MD, Nir Melamed, MD, Jason Burrows, MD, Sajit Augustine, MD, Lara Wesson, MD, Erin MacLellan, MD, James Hayward, MD, Victoria Allen, MD

a Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada 
b Department of Pediatrics, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia 
c Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada 
d Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada 
e Department of Obstetrics and Gynecology, Memorial University of Newfoundland and Labrador, St. John’s, Newfoundland, Canada 
f Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada 
g Department of Pediatrics, McGill University, Montreal, Québec, Canada 

∗ Corresponding author: Walid I. El-Naggar, MD.

Abstract

Background

Deferred cord clamping reduces mortality in preterm infants. However, there is a controversy about whether deferred cord clamping is as effective in cesarean delivery as in vaginal delivery.

Objective

This study aimed to compare the mortality and short-term outcomes of extremely preterm singleton infants who received deferred cord clamping after cesarean delivery with those who received deferred cord clamping after vaginal delivery and those who received early cord clamping after cesarean delivery.

Study Design

A national retrospective review of maternal, perinatal, and neonatal data of preterm infants born at <29 weeks of gestation who were admitted to units participating in the Canadian Neonatal Network between January 2015 and December 2022 was conducted. The rates and trends of deferred cord clamping (≥ 30 seconds) were evaluated, and the outcomes of infants who received deferred cord clamping after cesarean delivery were compared with (a) those who received deferred cord clamping after vaginal delivery and (b) those who received early cord clamping (<30 seconds) after caesarean delivery. The primary outcome was hospital mortality/severe brain injury (defined as grade 3/4 intraventricular hemorrhage and/or periventricular leukomalacia). Multivariate regression models with generalized estimating equations were used to account for clustering of infants within each site after adjusting for potential confounders.

Results

Of 6137 infants included in the study, 1952 (31.8%) received deferred cord clamping after cesarean delivery, 1804 (29.4%) received deferred cord clamping after vaginal delivery, and 2381 (38.8%) received early cord clamping after cesarean delivery at a median gestational age of 27 (interquartile range, 25–28), 26 (interquartile range, 25–28) and 26 (interquartile range, 25–28) weeks, respectively. There was a slow increase in the practice of deferred cord clamping in cesarean delivery from 32% in 2015 to approximately 50% in 2021–2022. After adjustment for potential confounders, infants who received deferred cord clamping after cesarean delivery had lower odds of a composite of mortality/severe brain injury (281/1952 [14%]) than those who received deferred cord clamping after vaginal delivery (347/1804 [19%]; adjusted odds ratio, 0.69 [95% confidence interval, 0.54–0.87]) and those who received early cord clamping after cesarean delivery (543/2381 [23%]; adjusted odds ratio, 0.69 [95% confidence interval, 0.57–0.83]). Deferred cord clamping after cesarean delivery was not associated with changes in other adverse short-term outcomes.

Conclusion

Deferred cord clamping was associated with a reduction in a composite of mortality/severe brain injury in singleton preterm infants born at <29 weeks of gestation via cesarean delivery.

Le texte complet de cet article est disponible en PDF.

Video


(22.0 Mo)

Le texte complet de cet article est disponible en PDF.

Key words : brain injury, cesarean delivery, deferred cord clamping, early cord clamping, morbidity, preterm infants, vaginal delivery


Plan


 The names of the Canadian Neonatal Network and Canadian Preterm Birth Network Investigators are listed in the Acknowledgments.
  This project was conducted with no specific financial support. The Canadian Institutes of Health Research (CIHR) funded the Canadian Preterm Birth Network (CPTBN; grant number: PBN 150642). Organizational support for the Canadian Neonatal Network (CNN) and the CPTBN was provided by the Maternal-Infant Care Research Centre at Mount Sinai Hospital in Toronto, Ontario, Canada. MiCare is supported by Mount Sinai Hospital , participating hospitals, and CIHR funding.
 The funding bodies had no role in the design or conduct of the study; the collection, management, analysis, or interpretation of the data; the preparation, review, or approval of the manuscript; or the decision to submit the manuscript 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.
 The authors report no conflict of interest.
 This study was presented at the Pediatric Academic Societies Meeting, Toronto, Ontario, Canada, May 2–6, 2024.


© 2025  The Author(s). Publié par Elsevier Masson SAS. Tous droits réservés.
Ajouter à ma bibliothèque Retirer de ma bibliothèque Imprimer
Export

    Export citations

  • Fichier

    •

  • Contenu

    •

Vol 234 - N° 2

P. 471-479 - février 2026 Retour au numéro
Article précédent Article précédent
  • Semi-supervised deep learning for uterus and bladder segmentation on female pelvic floor magnetic resonance imaging with limited labeled data
  • Jianwei Zuo, Fei Feng, Zhuhui Wang, James A. Ashton-Miller, John O.L. DeLancey, Jiajia Luo
| Article suivant Article suivant
  • Effect of transabdominal versus transvaginal cerclage on preterm birth and neonatal outcomes among patients with a history of cervical insufficiency
  • Chelsea J. Messinger, Sonia Hernández-Díaz, Albert Hofman, Natalie Sadlak, Jon Einarsson, Thomas F. McElrath

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.