459 - Physiological-Based Cord Clamping Versus Delayed Cord Clamping In Preterm Infants: A Retrospective Observational Study

Publication Number: 1441.459

Sofia Fatima Giuseppina Colombo, Buzzi Children’s Hospital -University of Milan, Milano, Lombardia, Italy; Gianluca Lista, Asst fbf Sacco, Milan, Lombardia, Italy; Francesca Castoldi, NICU V.Buzzi Children's Hospital, Milan, Lombardia, Italy; Elena Cesari, Buzzi children hospital, Milan, Lombardia, Italy; Valeria Savasi, University of Milan Italy, Milano, Lombardia, Italy; Valeria Anna Manfredini, Buzzi Hospital, Milano, Lombardia, Italy; Enrica Lupo, Children's Hospital Buzzi, Milano, Lombardia, Italy; Paola Fontana, NICU V.Buzzi Children's Hospital, Milan, Lombardia, Italy; Paola Azzurra La Verde, NICU VITTORE BUZZI CHILDRENS' HOSPITAL MILAN, Milan, Lombardia, Italy; Petrina Bastrenta, NICU V.Buzzi Children's Hospital, milano, Lombardia, Italy; Sara Gatto, Childrens’ Hospital Vittore Buzzi, Milan, Lombardia, Italy; Ilaria Stucchi, Vittore Buzzi Children's Hospital, Milano, Lombardia, Italy; Silvia Bianchi, Buzzi Children Hospital Milan, MILANO, Lombardia, Italy; Francesca Viaroli, NICU Buzzi children’s hospital, Milan, Lombardia, Italy; Valentina Pivetti, Ospedale dei Bambini V.Buzzi, Milan, Lombardia, Italy; Fabio Meneghin, NICU Vittore Buzzi Children's Hospital, Milan, Lombardia, Italy; Irene Daniele, NICU, V.Buzzi Children's Hospital, Milan, Milan, Lombardia, Italy; Samantha Rossi, Vittore Buzzi Children's Hospital, Milan, Lombardia, Italy; Cristina Ferrè, NICU V.Buzzi Children’s Hospital, Milan, Lombardia, Italy; Francesco Cavigioli, NICU V.Buzzi Children's Hospital Milan Italy, Milan, Lombardia, Italy

Background: Physiological-based cord clamping (PBCC) in neonatal resuscitation refers to clamping the umbilical cord after the onset of effective lung aeration using a resuscitation table at the bedside rather than cord clamping at a fixed time after birth. The use of PBCC is becoming more widespread in clinical practice, but additional research is required to better define its effects and clinical implications.

Objective: to evaluate the outcomes of newborns assisted at birth with PBCC versus delayed cord clamping (DCC) of one minute.

Design/Methods: This retrospective study included newborns < 32 weeks gestational age (GA) and/or ≤1500 g birth weight (BW), born between May 2023 and May 2025 at Vittore Buzzi Children's Hospital, Milan. Infants were divided into PBCC (36 - resuscitation performed using the Concord birth trolley®) and DCC (50 - No Concord group). Exclusion criteria were major congenital malformations, placental abruption, umbilical cord rupture, and comfort care in the delivery room. Primary outcomes were death, bronchopulmonary dysplasia (BPD), intraventricular haemorrhage (IVH), necrotizing enterocolitis (NEC), anemia, and need for inotropes in the first week.

Results: The PBCC Concord birth trolley® group had a lower mean GA (205.2 ± 14.8 days, ~29+2 weeks) and BW (1095 ± 285 g) compared with the DCC No Concord group (211 ± 17.9 days, ~30+1 weeks; 1248 ± 301 g), with BW differing significantly between groups (p = 0.020); demographic characteristics are shown in Figure 1. The PBCC Concord birth trolley® group also had a higher incidence of prenatal preeclampsia (p = 0.001) and IUGR (p = 0.017). No significant differences were observed in BPD, mortality, the composite outcome of BPD or death, IVH, NEC, use of inotropes in the first week, or 5-minute Apgar scores. Infants managed with the Concord birth trolley® more frequently received red blood cell transfusions (p = 0.043), with no differences in the number of transfusions per infant or age at first transfusion. Outcomes are shown in Figure 2.

Conclusion(s): No significant differences in the main outcomes (except for anemia) were observed; however, the small sample size limits the strength of these conclusions. In our study PBCC using the Concord birth trolley® was safe, compared with 1-minute DCC. Proper staff training and increasing experience with the trolley are essential to optimize neonatal resuscitation and may influence future results. Ongoing research is needed and should also take into account parental and team satisfaction, in addition to neonatal and maternal outcomes.

Figure 1 Demographic characteristics
Continuous variables are reported as mean ± SD and compared with Student's t-test; categorical variables as counts and percentages, compared using Chi-square or Fisher's exact test. Statistical significance was set at p< 0.05.

Figure 2 Outcomes
IUGR= intra uterine growth retardation; AGA Adeguate for gestational age birth weight; IVH intraventricular haemorrhage; PVL periventricular leukomalacia; NEC necrotizing enterocholitis; BPD bronchopulmonary dysplasia; Continuous variables are reported as mean ± SD and compared with Student's t-test; categorical variables as counts and percentages, compared using Chi-square or Fisher's exact test. Statistical significance was set at p< 0.05.