457 - Antepartum risk factors for Early Cord Clamping in infants require resuscitation.

Publication Number: 1439.457

Anup Katheria, University of California, San Diego School of Medicine, San Diego, CA, United States; Joseph Reiter, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Elizabeth Foglia, Children's Hospital of Philadelphia, Swarthmore, PA, United States; Paul Wildenhain, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Henry Lee, University of California San Diego, La Jolla, CA, United States; Katherine Coughlin, Sharp Mary Birch Hospital for Women and Newborns, San Diego, CA, United States; Vishal Kapadia, University of Texas Southwestern Medical School, Dallas, TX, United States

Background: Investigating perinatal risk factors that affect the adoption of deferred cord clamping (DCC) in infants requiring resuscitation is crucial to ensuring that it is both optimally and equally applied across this patient population who would benefit the most from an increase in placental transfusion.

Objective: To determine which antepartum risk factors could predict the provision of early cord clamping (ECC) using data from the DRIVE Database, which has been collecting information on cord management since 2023.

Design/Methods: A model was designed to identify which infants had the highest risk of ECC using stepwise logistic regression, classification and regression tree (CART) analysis. We hypothesized that a combination of antenatal factors such as gestational age, time of birth (morning/evening), mode of delivery, and race/ethnicity will have an impact on the timing of cord clamping. Inborn liveborn infants requiring resuscitation at DRIVE centers delivered between 07/2023-05/2025 were included. Infants with severe congenital anomalies or syndromes and infants receiving umbilical cord milking (because we are unable to discern from the records whether the infant was non-vigorous or whether milking was done routinely) were excluded. Early cord clamping was defined as waiting < 30 seconds, and deferred cord clamping (DCC) as ≥30 seconds. For multifetal pregnancies, counts were done on the individual infant level

Results: There were 10,713 infants eligible for analysis, (ECC, N=4369 vs DCC, N=6344) across 17 centers. Baseline maternal characteristics are shown in Table 1. The CART analysis categorized antenatal factors by center into 5 different groups (see Figure 1a and resultant CART Figure 1b). The CART model showed sufficient fit with a total of 10 subgroups. Figure 1a shows the rates of ECC across centers. The area under the receiver operator curve was 0.6765, 95% confidence interval (0.6666, 0.6863). The predictors for ECC with the highest relative importance were site (100%), followed by gestational age (27%), Hispanic ethnicity (8%), and multiple gestation (2%). Of note each of these predictors also had varied importance when evaluated by site (Table 2).

Conclusion(s): Our results suggest that among pregnancies of infants that require resuscitation, there are multiple factors that are associated with infants more likely to receive ECC. Further, there is evidence that the importance of such factors varies by center. Identifying center specific antenatal factors contributing to ECC can inform future research and encourage local and larger-scale quality improvement practice changes.

Table 1 Delivery characteristics
P-values shown are from Fisher's Exact test for binary variables and Wilcoxon Rank-Sum test for continuous variables. Mean and standard deviations (SD) are shown.

Figure 1
(A.) Site groups were determined by including the site id variable in the CART algorithm as a predictor of early cord clamping (ECC). The algorithm splits on site id 4 times. Receive operator characteristics 0.677 (bootstrapped 95% CI: 0.667, 0.686). Colors depicted demonstrate magenta indicates higher rates of ECC compared to cyan are lower rates of ECC (B.) Demonstrates site variability of ECC and shows CART group categories.

Table 2.
Group characteristics as shown in overall CART model
ECC: Early cord clamping.