Effect of Early versus Delayed Cord Clamping on Hematological Status of Preterm Infants at 6 wk of Age

Objective To compare the effect of early cord clamping (ECC) vs. delayed cord clamping (DCC) on hematocrit and serum ferritin at 6 wk of life in preterm infants. Methods This randomized controlled trial was conducted in the delivery room and neonatal intensive care unit of a tertiary hospital. One hundred preterminfants born between 30 0/7 and 36 6/7 wk were randomized to either early or delayed cord clamping groups. Parental informed consent was obtained prior to the delivery. In the ECC group, the cord was clamped immediately after the delivery of the baby and in the DCC group; the cord was clamped beyond 2 min after the baby was delivered. Hematocrit and serum ferritin at 6 wk of life were the primary outcomes. Incidence of anemia, polycythemia and significant jaundice were the main secondary outcomes. Results The mean hematocrit (27.3 +/- 3.8% vs. 31.8 +/- 3.5 %, p value 0.00) and the mean serum ferritin (136.9 +/- 83.8 ng/mL vs. 178.9 +/- 92.8 ng/mL, p value 0.037) at 6 wk of age were significantly higher in the infants randomized to DCC group. The hematocrit on day 1 was also significantly higher in the DCC group (50.8 +/- 5.2 % vs. 58.5 +/- 5.1 %, p value 0.00). The DCC group required significantly longer duration of phototherapy (55.3 +/- 40.0 h vs. 36.7 +/- 32.6 h, p value 0.016) and had a trend towards higher risk of polycythemia. Conclusions Delaying the cord clamping by 2 min, significantly improves the hematocrit value at birth and this beneficial effect continues till at least 2nd mo of life.