Timing of Umbilical Cord Clamping in Preterm Neonates: A Randomized Controlled Trial

Background: The optimal timing for clamping the umbilical cord remains controversial. This study aimed to assess the optimal timing of umbilical cord clamping and its effect on preterm neonates. Methods: The study was a randomized controlled trial with the registration number: NCT06000800. It was conducted at Kasr Al Ainy Maternity Hospital, Cairo University Hospital, where a total of 80 pregnant women were randomly pooled and randomly divided into four groups with each group comprising 20 pregnant women. Umbilical cord clamping was performed in the first group immediately (5 sec after birth), after 30 sec in the second group, after 60 sec in the third group, and after 90 sec in the fourth group. After birth, clinical and laboratory parameters were assessed and recorded at the 1(st), 6(th), 12(th), 24(th), and 48(th) hours for all preterm neonates. Results: Delayed cord clamping at 90 sec was linked to improved preterm neonatal outcomes including heart rate at the 1(st) and the 6(th) hours; respiratory rate at the 12(th) hour; oxygen saturation at the 1(st) hour; hemoglobin, hematocrit, and blood glucose levels at the 6(th), 12(th), 24(th), and 48(th) hours; but also linked to increase in bilirubin levels at the 12(th), 24(th), and 48(th )hours (P < 0.001). There was no statistically significant difference concerning APGAR score; respiratory rate at the 12(th )hour, temperature at the 1(st), 6(th), 12(th), 24(th), and 48(th) hours; hemoglobin, hematocrit, and blood glucose at the 1(st) hour; and bilirubin at the 1(st), 6(th), and 12(th) hours in all groups (5, 30, 60, and 90 sec) (P > 0.05). Conclusion: Better levels of blood glucose and hemoglobin were seen in preterm neonates whose cord clamping was delayed. Further studies should be carried out to determine the optimal timing of umbilical cord clamping with larger samples, for extended delay of clamping for more than 90 sec, and with recording of parameters for an extended period of follow-up even past the neonatal period.