666 - Association of deferred cord clamping in preterm infants born before 29 weeks of gestation with long-Term neurodevelopmental outcomes at three years of age.

Publication Number: 2649.666

Aditi Datta, University of Calgary Cumming School of Medicine, Calgary, AB, Canada; Khokan C. Sikdar, University of Calgary, Calgary, AB, Canada; Amina Benlamri, university of calgary, calgary, AB, Canada; Christina S.. Thornton, University of Calgary, Calgary, AB, Canada; Selphee Tang, Alberta Health Services, Calgary, AB, Canada; Abhay Lodha, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada

Background: Deferred cord clamping (DCC) has shown to improve hematological status and mitigate short term complications in preterm infants by promoting placental transfusion and allowing time for cardiorespiratory stabilization. However, evidence surrounding long-term neurodevelopmental (ND) outcomes at 3 years in infants born before 29 weeks' gestation remains limited.

Objective: To evaluate the association between DCC (≥15 seconds) and ND outcomes at 3 years corrected age, compared to immediate cord clamping (ICC, < 15 seconds) in preterm infants ( < 29 weeks).

Design/Methods: This retrospective cohort study included all preterm infants ( < 29 weeks) admitted to neonatal intensive care unit (NICU) at Foothills Medical Centre between July 1st, 2012, to December 31st, 2017, and evaluated at 3 years in the neonatal follow-up clinic. Infants with chromosomal abnormalities, major congenital anomalies, maternal antepartum haemorrhage or missing cord clamping data were excluded.
Primary outcome was a composite of mortality or any ND impairment (NDI), defined as presence of any of the following outcomes: cerebral palsy with Gross Motor Function Classification System score ≥1; cognitive/motor/language delay, Wechsler Preschool and Primary Scale of Intelligence, 4th edition, full scale IQ score < 85 or >1SD below the mean; sensorineural hearing loss/ auditory neuropathy with or without aid; visual impairment with corrected visual acuity of >20/60 in the better eye, or unilateral/bilateral blindness. Demographic and outcome variables were analyzed using univariate and multivariable logistic regressions, including propensity score matching.

Results: Among 299 eligible infants, 253 had data available at 3 years, 145 (57.31%) received DCC and 108 (42.69%) received ICC. Median gestational age and birth weight were significantly higher in the DCC group compared to the ICC group (27 weeks [IQR 26-28] vs 26 weeks [IQR 24-27]), p=0.001; and (900 grams [IQR 700-1050] vs 820 grams [IQR 620-1000], p=.004) (Table 1). Propensity score matched analysis showed DCC was associated with lower odds of death or any NDI (0.77; 95% CI: 0.64-0.90) and any NDI (0.73; 95% CI: 0.60-0.86). DCC was also associated with lower odds of cognitive delay and visual impairment (Table 2).

Conclusion(s): Deferred cord clamping was associated with decreased odds of composite outcome of death or any neurodevelopmental impairment and any neurodevelopmental impairment at 3 years corrected age in preterm infants born before 29 weeks' gestation.

Demographic, Maternal and Neonatal Characteristics


Neurodevelopmental Outcomes at 36 months corrected age