Article Text
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.
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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