Timing of umbilical cord clamping among infants born at 22 through 27 weeks' gestation

OBJECTIVE: To investigate the safety, feasibility and efficacy of delayed cord clamping (DCC) compared with immediate cord clamping (ICC) at delivery among infants born at 22 to 27 weeks' gestation. STUDY DESIGN: This was a pilot, randomized, controlled trial in which women in labor with singleton pregnancies at 22 to 27 weeks' gestation were randomly assigned to ICC (cord clamped at 5 to 10 s) or DCC (30 to 45 s). RESULTS: Forty mother-infant pairs were randomized. Infants in the ICC and DCC groups had mean gestational ages (GA) of 24.6 and 24.4 weeks, respectively. No differences were observed between the groups across all available safety measures, although infants in the DCC group had higher admission temperatures than infants in the ICC group (97.4 vs 96.2 degrees F, P = 0.04). During the first 24 h of life, blood pressures were lower in the ICC group than in the DCC group (P < 0.05), despite a threefold greater incidence of treatment for hypotension (45% vs 12%, P < 0.01). Infants in the ICC group had increased numbers of red blood transfusions (in first 28 days of life) than infants in DCC group (4.1 +/- 3.9 vs 2.8 +/- 2.2, P = 0.04). CONCLUSION: Among infants born at an average GA of 24 weeks', DCC appears safe, logistically feasible, and offers hematological and circulatory advantages compared with ICC. A more comprehensive appraisal of this practice is needed.