Cargando…
Randomised trial of cord clamping and initial stabilisation at very preterm birth
OBJECTIVES: For very preterm births, to compare alternative policies for umbilical cord clamping and immediate neonatal care. DESIGN: Parallel group randomised (1:1) trial, using sealed opaque numbered envelopes. SETTING: Eight UK tertiary maternity units. PARTICIPANTS: 261 women expected to have a...
Autores principales: | , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2018
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5750367/ https://www.ncbi.nlm.nih.gov/pubmed/28923985 http://dx.doi.org/10.1136/archdischild-2016-312567 |
_version_ | 1783289707388469248 |
---|---|
author | Duley, Lelia Dorling, Jon Pushpa-Rajah, Angela Oddie, Sam J Yoxall, Charles William Schoonakker, Bernard Bradshaw, Lucy Mitchell, Eleanor J Fawke, Joe Anthony |
author_facet | Duley, Lelia Dorling, Jon Pushpa-Rajah, Angela Oddie, Sam J Yoxall, Charles William Schoonakker, Bernard Bradshaw, Lucy Mitchell, Eleanor J Fawke, Joe Anthony |
author_sort | Duley, Lelia |
collection | PubMed |
description | OBJECTIVES: For very preterm births, to compare alternative policies for umbilical cord clamping and immediate neonatal care. DESIGN: Parallel group randomised (1:1) trial, using sealed opaque numbered envelopes. SETTING: Eight UK tertiary maternity units. PARTICIPANTS: 261 women expected to have a live birth before 32 weeks, and their 276 babies. INTERVENTIONS: Cord clamping after at least 2 min and immediate neonatal care with cord intact, or clamping within 20 s and immediate neonatal care after clamping. MAIN OUTCOME MEASURES: Intraventricular haemorrhage (IVH), death before discharge. RESULTS: 132 women (137 babies) were allocated clamping ≥2 min and neonatal care cord intact, and 129 (139) clamping ≤20 s and neonatal care after clamping; six mother-infant dyads were excluded (2, 4) as birth was after 35(+6) weeks, one withdrew (death data only available) (0, 1). Median gestation was 28.9 weeks for those allocated clamping ≥2 min, and 29.2 for those allocated clamping ≤20 s. Median time to clamping was 120 and 11 s, respectively. 7 of 135 infants (5.2%) allocated clamping ≥2 min died and 15 of 135 (11.1%) allocated clamping ≤20 s; risk difference (RD) −5.9% (95% CI −12.4% to 0.6%). Of live births, 43 of 134 (32%) had IVH vs 47 of 132 (36%), respectively; RD −3.5% (−14.9% to 7.8%). There were no clear differences in other outcomes for infants or mothers. CONCLUSIONS: This is promising evidence that clamping after at least 2 min and immediate neonatal care with cord intact at very preterm birth may improve outcome; a large trial is urgently needed. TRIAL REGISTRATION: ISRCTN 21456601. |
format | Online Article Text |
id | pubmed-5750367 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-57503672018-02-12 Randomised trial of cord clamping and initial stabilisation at very preterm birth Duley, Lelia Dorling, Jon Pushpa-Rajah, Angela Oddie, Sam J Yoxall, Charles William Schoonakker, Bernard Bradshaw, Lucy Mitchell, Eleanor J Fawke, Joe Anthony Arch Dis Child Fetal Neonatal Ed Original Article OBJECTIVES: For very preterm births, to compare alternative policies for umbilical cord clamping and immediate neonatal care. DESIGN: Parallel group randomised (1:1) trial, using sealed opaque numbered envelopes. SETTING: Eight UK tertiary maternity units. PARTICIPANTS: 261 women expected to have a live birth before 32 weeks, and their 276 babies. INTERVENTIONS: Cord clamping after at least 2 min and immediate neonatal care with cord intact, or clamping within 20 s and immediate neonatal care after clamping. MAIN OUTCOME MEASURES: Intraventricular haemorrhage (IVH), death before discharge. RESULTS: 132 women (137 babies) were allocated clamping ≥2 min and neonatal care cord intact, and 129 (139) clamping ≤20 s and neonatal care after clamping; six mother-infant dyads were excluded (2, 4) as birth was after 35(+6) weeks, one withdrew (death data only available) (0, 1). Median gestation was 28.9 weeks for those allocated clamping ≥2 min, and 29.2 for those allocated clamping ≤20 s. Median time to clamping was 120 and 11 s, respectively. 7 of 135 infants (5.2%) allocated clamping ≥2 min died and 15 of 135 (11.1%) allocated clamping ≤20 s; risk difference (RD) −5.9% (95% CI −12.4% to 0.6%). Of live births, 43 of 134 (32%) had IVH vs 47 of 132 (36%), respectively; RD −3.5% (−14.9% to 7.8%). There were no clear differences in other outcomes for infants or mothers. CONCLUSIONS: This is promising evidence that clamping after at least 2 min and immediate neonatal care with cord intact at very preterm birth may improve outcome; a large trial is urgently needed. TRIAL REGISTRATION: ISRCTN 21456601. BMJ Publishing Group 2018-01 2017-09-18 /pmc/articles/PMC5750367/ /pubmed/28923985 http://dx.doi.org/10.1136/archdischild-2016-312567 Text en © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted. This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/ |
spellingShingle | Original Article Duley, Lelia Dorling, Jon Pushpa-Rajah, Angela Oddie, Sam J Yoxall, Charles William Schoonakker, Bernard Bradshaw, Lucy Mitchell, Eleanor J Fawke, Joe Anthony Randomised trial of cord clamping and initial stabilisation at very preterm birth |
title | Randomised trial of cord clamping and initial stabilisation at very preterm birth |
title_full | Randomised trial of cord clamping and initial stabilisation at very preterm birth |
title_fullStr | Randomised trial of cord clamping and initial stabilisation at very preterm birth |
title_full_unstemmed | Randomised trial of cord clamping and initial stabilisation at very preterm birth |
title_short | Randomised trial of cord clamping and initial stabilisation at very preterm birth |
title_sort | randomised trial of cord clamping and initial stabilisation at very preterm birth |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5750367/ https://www.ncbi.nlm.nih.gov/pubmed/28923985 http://dx.doi.org/10.1136/archdischild-2016-312567 |
work_keys_str_mv | AT duleylelia randomisedtrialofcordclampingandinitialstabilisationatverypretermbirth AT dorlingjon randomisedtrialofcordclampingandinitialstabilisationatverypretermbirth AT pushparajahangela randomisedtrialofcordclampingandinitialstabilisationatverypretermbirth AT oddiesamj randomisedtrialofcordclampingandinitialstabilisationatverypretermbirth AT yoxallcharleswilliam randomisedtrialofcordclampingandinitialstabilisationatverypretermbirth AT schoonakkerbernard randomisedtrialofcordclampingandinitialstabilisationatverypretermbirth AT bradshawlucy randomisedtrialofcordclampingandinitialstabilisationatverypretermbirth AT mitchelleleanorj randomisedtrialofcordclampingandinitialstabilisationatverypretermbirth AT fawkejoeanthony randomisedtrialofcordclampingandinitialstabilisationatverypretermbirth |