Delayed versus Immediate Cord Clamping in Preterm Infants

被引：208

作者：

Tarnow-Mordi, W. ^{[1
]}

Morris, J. ^{[2
]}

Kirby, A. ^{[1
]}

Robledo, K. ^{[1
]}

Askie, L. ^{[1
]}

Brown, R. ^{[1
]}

Evans, N. ^{[2
]}

Finlayson, S. ^{[1
]}

Fogarty, M. ^{[2
]}

Gebski, V. ^{[1
]}

Ghadge, A. ^{[1
]}

Hague, W. ^{[1
]}

Isaacs, D. ^{[2
]}

Jeffery, M. ^{[2
]}

Keech, A. ^{[1
]}

Kluckow, M. ^{[2
]}

Popat, H. ^{[2
]}

Sebastian, L. ^{[1
]}

Aagaard, K. ^{[15
]}

Belfort, M. ^{[15
]}

Pammi, M. ^{[15
]}

Abdel-Latif, M. ^{[5
]}

Reynolds, G. ^{[5
]}

Ariff, S. ^{[16
]}

Sheikh, L. ^{[16
]}

Chen, Y. ^{[3
]}

Colditz, P. ^{[6
]}

Liley, H. ^{[2
,6
]}

Pritchard, M. ^{[6
]}

de Luca, D. ^{[17
]}

de Waal, K. ^{[13
]}

Forder, P. ^{[13
]}

Duley, L. ^{[18
]}

El-Naggar, W. ^{[19
]}

Gill, A. ^{[8
]}

Newnham, J. ^{[8
]}

Simmer, K. ^{[8
]}

Groom, K. ^{[20
]}

Weston, P. ^{[21
]}

Gullam, J. ^{[21
]}

Patel, H. ^{[21
]}

Koh, G. ^{[7
]}

Lui, K. ^{[4
]}

Marlow, N. ^{[22
]}

Morris, S. ^{[9
]}

Sehgal, A. ^{[10
]}

Wallace, E. ^{[10
]}

Soll, R. ^{[24
]}

Young, L. ^{[24
]}

Sweet, D. ^{[23
]}

机构：

[1] Univ Sydney, Natl Hlth & Med Res Council Clin Trials Ctr, Sydney, NSW, Australia

[2] Univ Sydney, Sydney, NSW, Australia

[3] Royal North Shore Hosp, Sydney, NSW, Australia

[4] Univ New South Wales, Sydney, NSW, Australia

[5] Australian Natl Univ, Canberra, ACT, Australia

[6] Univ Queensland, Brisbane, Qld, Australia

[7] James Cook Univ, Cairns, Australia

[8] Univ Western Australia, Perth, WA, Australia

[9] Flinders Univ S Australia, Adelaide, SA, Australia

[10] Monash Univ, Clayton, Vic, Australia

[11] Univ Melbourne, Melbourne, Vic, Australia

[12] Mercy Hosp Women, Heidelberg, Vic, Australia

[13] Univ Newcastle, Newcastle, NSW, Australia

[14] Univ Wollongong, Wollongong, NSW, Australia

[15] Baylor Coll Med, Houston, TX 77030 USA

[16] Aga Khan Univ Hosp, Karachi, Pakistan

[17] Hop Antoine Beclere, Clamart, France

[18] Univ Nottingham, Nottingham, England

[19] Dalhousie Univ, Halifax, NS, Canada

[20] Univ Auckland, Auckland, New Zealand

[21] Univ Otago, Dunedin, New Zealand

[22] UCL, London, England

[23] Royal Jubilee Matern Hosp, Belfast, Antrim, North Ireland

[24] Univ Vermont, Burlington, VT 05405 USA

来源：

NEW ENGLAND JOURNAL OF MEDICINE | 2017年 / 377卷 / 25期

基金：

英国医学研究理事会; 澳大利亚国家健康与医学研究理事会;

关键词：

HEMATOPOIETIC-CELL TRANSPLANTATION; PREVENT CYTOMEGALOVIRUS DISEASE; ANTICYTOMEGALOVIRUS COMPOUND AIC246; IN-VITRO; MARROW-TRANSPLANTATION; DOUBLE-BLIND; GANCICLOVIR PROPHYLAXIS; MARIBAVIR PROPHYLAXIS; LETERMOVIR RESISTANCE; PREEMPTIVE TREATMENT;

D O I：

10.1056/NEJMoa1711281

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND The preferred timing of umbilical-cord clamping in preterm infants is unclear. METHODS We randomly assigned fetuses from women who were expected to deliver before 30 weeks of gestation to either immediate clamping of the umbilical cord (<= 10 seconds after delivery) or delayed clamping (60 seconds after delivery). The primary composite outcome was death or major morbidity (defined as severe brain injury on postnatal ultrasonography, severe retinopathy of prematurity, necrotizing enterocolitis, or late-onset sepsis) by 36 weeks of postmenstrual age. Analyses were performed on an intention-to-treat basis, accounting for multiple births. RESULTS Of 1634 fetuses that underwent randomization, 1566 were born alive before 30 weeks of gestation; of these, 782 were assigned to immediate cord clamping and 784 to delayed cord clamping. The median time between delivery and cord clamping was 5 seconds and 60 seconds in the respective groups. Complete data on the primary outcome were available for 1497 infants (95.6%). There was no significant difference in the incidence of the primary outcome between infants assigned to delayed clamping (37.0%) and those assigned to immediate clamping (37.2%) (relative risk, 1.00; 95% confidence interval, 0.88 to 1.13; P = 0.96). The mortality was 6.4% in the delayed-clamping group and 9.0% in the immediate-clamping group (P = 0.03 in unadjusted analyses; P = 0.39 after post hoc adjustment for multiple secondary outcomes). There were no significant differences between the two groups in the incidences of chronic lung disease or other major morbidities. CONCLUSIONS Among preterm infants, delayed cord clamping did not result in a lower incidence of the combined outcome of death or major morbidity at 36 weeks of gestation than immediate cord clamping. (Funded by the Australian National Health and Medical Research Council [NHMRC] and the NHMRC Clinical Trials Centre; APTS Australian and New Zealand Clinical Trials Registry number, ACTRN12610000633088.)

引用

页码：2445 / 2455

页数：11

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