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Am J Perinatol 2024; 41(S 01): e2444-e2453
DOI: 10.1055/a-2115-4360
Original Article

Impact of Delayed Cord Clamping on Red Blood Cell Transfusion and Related Outcomes in Very Low Birth Weight Infants

Mayuri Patel
1   Division of Neonatology, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland
,
Mathangi Gopalakrishnan
2   Department of Practice, Science, and Health Outcomes Research, Center for Translational Medicine, University of Maryland School of Pharmacy, Baltimore, Maryland
,
Sripriya Sundararajan 
1   Division of Neonatology, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland
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Abstract

Objective Delayed cord clamping (DCC) for 30 to 60 seconds after birth facilitates placental transfusion, increases blood volume, and decreases red blood cell (RBC) transfusion in preterm infants. Study objective was to determine (1) RBC transfusion burden over a 5-year period, (2) impact of DCC practice on RBC transfusions, and (3) association of RBC transfusion on outcomes in very low birthweight (VLBW) preterm infants.

Study Design A retrospective medical chart review was performed in 787 VLBW infants between 2016 and 2020. Demographic factors, DCC status, number of RBC transfusions, and neonatal outcomes were determined in eligible infants. Adjusted association between DCC, RBC transfusion, and outcomes were determined using logistic and linear regression methods.

Results Of the 538 eligible VLBW infants, 62% (N = 332) received RBC transfusions. Proportion receiving RBC transfusion were significantly higher for infants <1,000 g (N = 217, 65.4%) and gestational age (GA) <29 weeks (N = 256, 77.1%) than larger (1,001–1,250 g, N = 77, 23.2% and 1,251–1,500 g, N = 38, 11.4%) and older GA ≥ 29 weeks' infants (N = 76, 22.9%, p < 0.05). Of the 81/538 (15.1%) who received DCC, 48 (59.2%) received no RBC transfusion (p < 0.001). In multivariable logistic regression analysis, preterm infants with DCC were 55% less likely to receive RBC transfusions as compared with infants with no DCC. At any given GA, the number of RBC transfusions in preterm infants with DCC was 25% lower as compared with infants without DCC (p < 0.05). Transfusion was associated with 8-fold increased odds for bronchopulmonary dysplasia and 4-fold increased odds for medical and surgically treated patent ductus arteriosus compared with no transfusion. There was no significant association of transfusion with neonatal sepsis, laser treated retinopathy of prematurity, necrotizing enterocolitis, and intraventricular hemorrhage.

Conclusion DCC was significantly associated with reduced RBC transfusion, but fewer preterm infants received DCC. Further research is needed to explore the feasibility of providing neonatal resuscitation during DCC in preterm infants.

Key Points

  • Delayed cord clamping significantly reduced the need for RBC transfusions.

  • Fewer very preterm infants received DCC.

  • Future research is needed to explore feasibility of neonatal resuscitation during DCC.

Keywords

delayed cord clamping - red blood cell transfusions - very low birth weight - neonatal outcomes - quality improvement project

Supplementary Material



Publication History

Received: 10 February 2023

Accepted: 21 June 2023

Accepted Manuscript online:
22 June 2023

Article published online:
29 July 2023

© 2023. Thieme. All rights reserved.

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