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A randomized controlled trial of a 30-second versus a 120- second delay in cord clamping after term birth.

BACKGROUND
Delayed cord clamping (DCC) has been recently adopted in neonatal resuscitation. The immediate cardiac hemodynamic effects related to delayed cord clamping more than 30 seconds was not studied. We aimed to study the effect of delayed cord clamping (DCC) at 120 seconds compared to 30 seconds on multiple hemodynamic variables in full term infants using an electrical cardiometry device.


DESIGN
A randomized clinical trial Setting: Full term infants who delivered at Obstetrics and Gynecology Department at Cairo University Hospital.


PATIENTS
Sixty- eight full term infants were successfully enrolled in this trial. Cardiac output and other hemodynamic parameters were evaluated in this study by electrical cardiometry (EC) device. Hemoglobin, glucose, and bilirubin concentrations were measured at 24 hours.


INTERVENTION
Newborn infants were assigned randomly into group 1: DCC at 30s and group 2: DCC at 120s, based on the time of cord clamping.


RESULTS
Stoke volume (ml) and cardiac output (L/min) were significantly higher in group 2 compared to group 1 at 5 minutes (6.71 vs 5.35 and 1.09 vs 0.75), 10 minutes (6.43 vs 5.59 and 0.88 vs 0.77),15 minutes (6.45 vs 5.60 and 0.89 vs 0.76) and 24 hours (6.67 vs 5.75 and 0.91vs 0.81), respectively. Index of contractility (ICON) (units) was significantly increased in group 2 at 5 minutes compared to group1 (114.2 vs 83.8). Hematocrit (%) and total bilirubin concentrations (mg/dL) at 24 hours were significantly increased in group 2 compared to group 1 (51.5 vs 40.5 and 3.8 vs 2.9, respectively).


CONCLUSIONS
Stroke volume and cardiac output are significantly higher in neonates with DCC at 120 seconds compared to DCC at 30 seconds that continues for the first 24h.