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Effect of timing of umbilical cord clamping on cerebral regional tissue oxygenation: a secondary analysis of the COSGOD III trial
  1. Tina Perme1,2,
  2. Lilijana Kornhauser Cerar3,
  3. Bernhard Schwaberger4,
  4. Berndt Urlesberger5,
  5. Christina Helene Wolfsberger6,
  6. Nariae Baik7,
  7. Katharina Goeral8,
  8. Marlene Hammerl9,
  9. Eugene M Dempsey10,11,
  10. Laila Springer12,
  11. Gianluca Lista13,
  12. Tomasz Szczapa14,
  13. Hans Fuchs15,
  14. Lukasz Karpinski16,
  15. Jenny Bua17,
  16. Alexander Avian18,
  17. Brenda Hiu Yan Law19,
  18. Julia Buchmayer20,
  19. Ursula Kiechl-Kohlendorfer21,
  20. Christoph E Schwarz22,
  21. Kerstin Gruendler23,
  22. Ilaria Stucchi24,
  23. Katrin Klebermass-Schrehof25,
  24. Georg M Schmölzer26,
  25. Gerhard Pichler27
  26. on behalf of the COSGOD III study group
  1. 1University Medical Centre Ljubljana, Ljubljana, Slovenia
  2. 2Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
  3. 3Division of Gynaecology and Obstetrics, Ljubljanski Univerzitetni Klinicni Center, Ljubljana, Slovenia
  4. 4Department of Pediatrics, Division of Neonatology, Medical University of Graz, Graz, Austria
  5. 5Paediatrics, University of Graz, Graz, Austria
  6. 6Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
  7. 7Research Unit for Neonatal Microcirculation and Macrocirculation, Medical University Graz, Graz, Austria
  8. 8Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Intensive Care and Pediatric Neurology, Medical University Vienna, Vienna, Austria
  9. 9Department of Pediatrics II, Neonatology, Medical University of Innsbruck, Innsbruck, Austria
  10. 10Department of Paediatrics and Child Health, University College Cork, Wilton, Ireland
  11. 11Infant Centre, University College Cork, Wilton, Ireland
  12. 12Neonatology, Universitätsklinikum Tübingen, Tubingen, Germany
  13. 13Ospedale dei Bambini “V.Buzzi”, Milano, Italy
  14. 14II Department of Neonatology, Uniwersytet Medyczny imienia Karola Marcinkowskiego w Poznaniu, Poznan, Poland
  15. 15Neonatology and Ped Intensive Care, Center of Pediatrics, University of Freiburg, Freiburg, Germany
  16. 16II Department of Neonatology, Poznan University of Medical Sciences, Poznan, Poland
  17. 17Department of Neonatology, Institute for Maternal and Child Health IRCCS "Burlo Garofolo”, Trieste, Italy
  18. 18Institute for Medical informatics, Statistics and Documentation, Medical University Graz, Graz, Austria
  19. 19Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
  20. 20Neonatology, Medical University of Vienna, Vienna, Austria
  21. 21Deparment of Pediatrics II, Medical University Innsbruck, Innsbruck, Austria
  22. 22Cork University Maternity Hospital, Cork, Ireland
  23. 23Neonatology, Children's University Hospital Tuebingen, Tuebingen, Germany
  24. 24Ospedale dei Bambini Vittore Buzzi, Milano, Italy
  25. 25Pediatrics, Medical University of Vienna, Vienna, Austria
  26. 26Neonatology, Royal Alexandra Hospital, Edmonoton, Alberta, Canada
  27. 27Pediatrics, Medical University Graz, Graz, Austria
  1. Correspondence to Dr Tina Perme; tina.perme{at}gmail.com

Abstract

Aim To determine how different cord clamping strategies affect cerebral oxygenation in the first 15 min after birth in preterm infants.

Methods A post-hoc secondary outcome analysis of a multicentre prospective randomised clinical trial (COSGOD III) conducted between October 2017 and October 2021 in 11 tertiary neonatal intensive care units in six countries in Europe and in Canada. In the present ancillary study, all included premature neonates (<32 weeks gestation) were retrospectively assigned to three groups according to the timing of cord clamping (G1<30 s, G2 30–60 s, G3>30 s). The aim of this study was to evaluate differences in cerebral regional oxygen saturation (crSO2) and cerebral fractional tissue oxygen extraction (cFTOE) within the first 15 min after birth in preterm neonates based on the timing of cord clamping.

Results 572 infants (n=339 (G1), n=164 (G2) and n=69 (G3)) were included in the final ancillary analysis. There were no statistically significant differences in crSO2 and cFTOE between the three groups. There were no statistically significant differences between the three groups in neonatal morbidities, particularly importantly in the degree of cerebral injury, as measured by any degree of intraventricular haemorrhage or cystic periventricular leukomalacia.

Conclusions No significant differences in crSO2 and cFTOE during the first 15 min after birth were observed; however, some effect may have been modified by protocol-guided titration of supplemental oxygen in the intervention arm. Thus, in our study, we did not find a correlation between deferred cord clamping and improved cerebral oxygenation immediately after birth.

Trial registration number NCT03166722.

  • Intensive Care Units, Neonatal
  • Neonatology
  • Resuscitation

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Footnotes

  • X @Research4Babies

  • Deceased 2024

  • Contributors TP is the guarantor. TP: Writing—review and editing, Writing—original draft, Visualisation, Project administration, Methodology, Investigation, Formal analysis, Conceptualisation. Guarantor. LKC: Writing –review and editing, Validation, Investigation, Supervision. BS: Writing—review and editing, Validation, Investigation. BU: Writing—review and editing, Validation, Investigation. CHW: Writing—review and editing, Validation, Investigation. NB: Writing—review and editing, Validation, Investigation. KG: Writing—review and editing, Validation, Investigation. MH: Writing—review and editing, Validation, Investigation. EMD: Writing—review and editing, Validation, Investigation, Funding acquisition. LS: Writing—review and editing, Validation, Investigation. GL: Writing—review and editing, Validation, Investigation. TS: Writing—review and editing, Validation, Investigation. HF: Writing—review and editing, Validation, Investigation. LK: Writing—review and editing, Validation, Investigation. JBua: Writing—review and editing, Validation, Investigation. AA: Writing—review and editing, Validation, Methodology, Formal analysis, Data curation. BHYL: Writing—review and editing, Validation, Investigation. JBuc: Writing—review and editing, Validation, Investigation. UK-K: Writing—review and editing, Validation, Investigation. CES: Writing—review and editing, Validation, Investigation. KG: Writing—review and editing, Validation, Investigation. IS: Writing—review and editing, Validation, Investigation. KK-S: Writing—review and editing, Validation, Investigation. GMS: Writing—review and editing, Visualisation, Validation, Supervision, Project administration, Methodology, Investigation, Funding acquisition, Conceptualisation. GP: Writing—review and editing, Visualisation, Validation, Supervision, Project administration, Methodology, Investigation, Funding acquisition, Formal analysis, Conceptualisation. COSGOD III study group: Investigation.

  • Funding The COSGOD III trial was funded by the Austrian Science Fund (Fonds zur Förderung der wissenschaftlichen Forschung (FWF) Austria) through an unconditional and unrestricted grant (KLI 586-B31). The COSGOD III trial received support from the Austrian Science Fund and the Health Research Board (HRB), Clinical Research Facility at the University of Cork for the submitted work and from the Stollery Children’s Hospital Foundation facilitated by the Women and Children’s Health Research Institute; no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work. Health Research Board (HRB) Clinical Research Facility at University College Cork supported the study at the Infant Centre, University College Cork, Cork University Maternity Hospital, Cork, Ireland. GMS was a recipient of the Heart and Stroke Foundation/University of Alberta Professorship of Neonatal Resuscitation, a National New Investigator of the Heart and Stroke Foundation Canada and an Alberta New Investigator of the Heart and Stroke Foundation Alberta. This research was facilitated by the Women and Children’s Health Research Institute through the support of the Stollery Children’s Hospital Foundation. No funding was received for the analysis of the data presented in the submitted manuscript, and funders had no influence on analysis, and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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