TY - JOUR
T1 - Exposure to umbilical cord management approaches and death or neurodevelopmental impairment at 22-26 months' corrected age after extremely preterm birth
AU - Handley, Sara C.
AU - Kumbhat, Neha
AU - Eggleston, Barry
AU - Foglia, Elizabeth E.
AU - Davis, Alexis S.
AU - Van Meurs, Krisa
AU - Lakshminrusimha, Satyan
AU - Walsh, Michele
AU - Watterberg, Kristi L.
AU - Wyckoff, Myra H.
AU - Das, Abhik
AU - DeMauro, Sara B.
N1 - Publisher Copyright:
© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2023/5/1
Y1 - 2023/5/1
N2 - Objective To compare death or severe neurodevelopmental impairment (NDI) at 22-26 months' corrected age (CA) among extremely preterm infants following exposure to different forms of umbilical cord management. Design Retrospective study. Setting Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network registry. Patients Infants born <27 weeks' gestation in 2016-2018 without severe congenital anomalies who received active treatment after birth and underwent neurodevelopmental assessments between 22 and 26 months' CA. Exposures Immediate cord clamping (ICC), delayed cord clamping (DCC) or umbilical cord milking (UCM). Main outcomes and measure Primary composite outcome of death or severe NDI at 22-26 months' CA, defined as severe cerebral palsy, Bayley-III cognitive/motor composite score <70, bilateral deafness or blindness; individual components were examined as secondary outcomes. Multivariable regression examined associations, adjusting for risk factors identified a priori and potential confounders. Mediation analysis explored the effect of severe intraventricular haemorrhage (IVH) on the exposure-outcome relationship. Results Among 1900 infants, 64.1% were exposed to ICC, 27.8% to DCC and 8.1% to UCM. Compared with ICC-exposed infants, DCC-exposed infants had lower odds of death or severe NDI (adjusted OR 0.64, 95% CI 0.50 to 0.83). No statistically significant differences were observed when comparing UCM with either ICC or DCC, or between secondary outcomes across groups. Association between cord management and the primary outcome was not mediated by severe IVH. Conclusion Compared with ICC, DCC exposure was associated with lower death or severe NDI at 22-26 months' CA among extremely preterm infants, which was not mediated by severe IVH.
AB - Objective To compare death or severe neurodevelopmental impairment (NDI) at 22-26 months' corrected age (CA) among extremely preterm infants following exposure to different forms of umbilical cord management. Design Retrospective study. Setting Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network registry. Patients Infants born <27 weeks' gestation in 2016-2018 without severe congenital anomalies who received active treatment after birth and underwent neurodevelopmental assessments between 22 and 26 months' CA. Exposures Immediate cord clamping (ICC), delayed cord clamping (DCC) or umbilical cord milking (UCM). Main outcomes and measure Primary composite outcome of death or severe NDI at 22-26 months' CA, defined as severe cerebral palsy, Bayley-III cognitive/motor composite score <70, bilateral deafness or blindness; individual components were examined as secondary outcomes. Multivariable regression examined associations, adjusting for risk factors identified a priori and potential confounders. Mediation analysis explored the effect of severe intraventricular haemorrhage (IVH) on the exposure-outcome relationship. Results Among 1900 infants, 64.1% were exposed to ICC, 27.8% to DCC and 8.1% to UCM. Compared with ICC-exposed infants, DCC-exposed infants had lower odds of death or severe NDI (adjusted OR 0.64, 95% CI 0.50 to 0.83). No statistically significant differences were observed when comparing UCM with either ICC or DCC, or between secondary outcomes across groups. Association between cord management and the primary outcome was not mediated by severe IVH. Conclusion Compared with ICC, DCC exposure was associated with lower death or severe NDI at 22-26 months' CA among extremely preterm infants, which was not mediated by severe IVH.
KW - epidemiology
KW - neonatology
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U2 - 10.1136/archdischild-2022-324565
DO - 10.1136/archdischild-2022-324565
M3 - Article
C2 - 36253076
AN - SCOPUS:85142039918
SN - 1359-2998
VL - 108
SP - F224-F231
JO - Archives of Disease in Childhood: Fetal and Neonatal Edition
JF - Archives of Disease in Childhood: Fetal and Neonatal Edition
IS - 3
ER -