Placental transfusion and short-term outcomes among extremely preterm infants

Neha Kumbhat; Barry Eggleston; Alexis S. Davis; Krisa P. Van Meurs; Sara Bonamo Demauro; Elizabeth E. Foglia; Satyanarayan Lakshminrusimha; Michele C. Walsh; Kristi L. Watterberg; Myra H. Wyckoff; Abhik Das; Sara C. Handley

doi:10.1136/archdischild-2019-318710

Placental transfusion and short-term outcomes among extremely preterm infants

Neha Kumbhat, Barry Eggleston, Alexis S. Davis, Krisa P. Van Meurs, Sara Bonamo Demauro, Elizabeth E. Foglia, Satyanarayan Lakshminrusimha, Michele C. Walsh, Kristi L. Watterberg, Myra H. Wyckoff, Abhik Das, Sara C. Handley

Research output: Contribution to journal › Article › peer-review

11 Scopus citations

Abstract

Objective To compare short-term outcomes after placental transfusion (delayed cord clamping (DCC) or umbilical cord milking (UCM)) versus immediate cord clamping among extremely preterm infants. Design Retrospective study. Setting The Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network registry. Patients Infants born <29 weeks' gestation in 2016 or 2017 without congenital anomalies who received active treatment after delivery. Intervention/exposure DCC or UCM. Main outcome measures Primary outcomes: (1) composite of mortality or major morbidity by 36 weeks' postmenstrual age (PMA); (2) mortality by 36 weeks PMA and (3) composite of major morbidities by 36 weeks' PMA. Secondary composite outcomes: (1) any grade intraventricular haemorrhage or mortality by 36 weeks' PMA and (2) hypotension treatment in the first 24 postnatal hours or mortality in the first 12 postnatal hours. Outcomes were assessed using multivariable regression, adjusting for mortality risk factors identified a priori, significant confounders and centre as a random effect. Results Among 3116 infants, 40% were exposed to placental transfusion, which was not associated with the primary composite outcome of mortality or major morbidity by 36 weeks' PMA (adjusted OR (aOR) 1.26, 95% CI 0.95 to 1.66). However, exposure was associated with decreased mortality by 36 weeks' PMA (aOR 0.71, 95% CI 0.55 to 0.92) and decreased hypotension treatment in first 24 postnatal hours (aOR 0.66, 95% CI 0.53 to 0.82). Conclusion In this extremely preterm infant cohort, exposure to placental transfusion was not associated with the composite outcome of mortality or major morbidity, though there was a reduction in mortality by 36 weeks' PMA. Trial registration number NCT00063063.

Original language	English (US)
Pages (from-to)	62-68
Number of pages	7
Journal	Archives of Disease in Childhood: Fetal and Neonatal Edition
Volume	106
Issue number	1
DOIs	https://doi.org/10.1136/archdischild-2019-318710
State	Published - Jan 1 2021

Keywords

epidemiology
mortality
neonatology
outcomes research
procedures

ASJC Scopus subject areas

Pediatrics, Perinatology, and Child Health
Obstetrics and Gynecology

Access to Document

10.1136/archdischild-2019-318710

Cite this

Kumbhat, N., Eggleston, B., Davis, A. S., Van Meurs, K. P., Demauro, S. B., Foglia, E. E., Lakshminrusimha, S., Walsh, M. C., Watterberg, K. L., Wyckoff, M. H., Das, A., & Handley, S. C. (2021). Placental transfusion and short-term outcomes among extremely preterm infants. Archives of Disease in Childhood: Fetal and Neonatal Edition, 106(1), 62-68. https://doi.org/10.1136/archdischild-2019-318710

Kumbhat, N, Eggleston, B, Davis, AS, Van Meurs, KP, Demauro, SB, Foglia, EE, Lakshminrusimha, S, Walsh, MC, Watterberg, KL, Wyckoff, MH, Das, A & Handley, SC 2021, 'Placental transfusion and short-term outcomes among extremely preterm infants', Archives of Disease in Childhood: Fetal and Neonatal Edition, vol. 106, no. 1, pp. 62-68. https://doi.org/10.1136/archdischild-2019-318710

@article{c459ea424b5b4b769f57f992405e8d0c,

title = "Placental transfusion and short-term outcomes among extremely preterm infants",

abstract = "Objective To compare short-term outcomes after placental transfusion (delayed cord clamping (DCC) or umbilical cord milking (UCM)) versus immediate cord clamping among extremely preterm infants. Design Retrospective study. Setting The Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network registry. Patients Infants born <29 weeks' gestation in 2016 or 2017 without congenital anomalies who received active treatment after delivery. Intervention/exposure DCC or UCM. Main outcome measures Primary outcomes: (1) composite of mortality or major morbidity by 36 weeks' postmenstrual age (PMA); (2) mortality by 36 weeks PMA and (3) composite of major morbidities by 36 weeks' PMA. Secondary composite outcomes: (1) any grade intraventricular haemorrhage or mortality by 36 weeks' PMA and (2) hypotension treatment in the first 24 postnatal hours or mortality in the first 12 postnatal hours. Outcomes were assessed using multivariable regression, adjusting for mortality risk factors identified a priori, significant confounders and centre as a random effect. Results Among 3116 infants, 40% were exposed to placental transfusion, which was not associated with the primary composite outcome of mortality or major morbidity by 36 weeks' PMA (adjusted OR (aOR) 1.26, 95% CI 0.95 to 1.66). However, exposure was associated with decreased mortality by 36 weeks' PMA (aOR 0.71, 95% CI 0.55 to 0.92) and decreased hypotension treatment in first 24 postnatal hours (aOR 0.66, 95% CI 0.53 to 0.82). Conclusion In this extremely preterm infant cohort, exposure to placental transfusion was not associated with the composite outcome of mortality or major morbidity, though there was a reduction in mortality by 36 weeks' PMA. Trial registration number NCT00063063.",

keywords = "epidemiology, mortality, neonatology, outcomes research, procedures",

author = "Neha Kumbhat and Barry Eggleston and Davis, {Alexis S.} and {Van Meurs}, {Krisa P.} and Demauro, {Sara Bonamo} and Foglia, {Elizabeth E.} and Satyanarayan Lakshminrusimha and Walsh, {Michele C.} and Watterberg, {Kristi L.} and Wyckoff, {Myra H.} and Abhik Das and Handley, {Sara C.}",

note = "Funding Information: 1Neonatology, Fetal and Neonatal Institute, Division of Neonatology, Children{\textquoteright}s Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California, USA 2Division of Neonatology, Lucile Packard Children{\textquoteright}s Hospital, Palo Alto, California, USA 3Biostatistics and Epidemiology, RTI International, Research Triangle Park, North Carolina, USA 4Department of Pediatrics, Division of Neonatology, Children{\textquoteright}s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA 5UC Davis, Davis, California, USA 6Pediatrics, Case Western Reserve University, Cleveland, Ohio, USA 7Department of Paediatrics, University of New Mexico, Albuquerque, New Mexico, USA 8Pediatrics, UT Southwestern Medical Center at Dallas, Dallas, Texas, USA 9RTI International, Rockville, Maryland, USA Acknowledgements The authors acknowledge the National Institutes of Health, the Eunice Kennedy Shriver NICHD and the National Center for Advancing Translational Sciences (NCATS) for providing grant support for the NRN{\textquoteright}s GDB Study through cooperative agreements. While NICHD staff had input into the study design, conduct, analysis and manuscript drafting, the comments and views of the authors do not necessarily represent the views of NICHD, the National Institutes of Health, the Department of Health and Human Services or the US Government. Participating NRN sites collected data and transmitted it to RTI International, the data coordinating center (DCC) for the network, which stored, managed and analysed the data for this study. On behalf of the NRN, RTI International had full access to all of the data in the study, and with the NRN Center Principal Investigators, takes responsibility for the integrity of the data and accuracy of the data analysis. We are indebted to our medical and nursing colleagues and the infants and their parents who agreed to take part in this study. The following investigators, in addition to those listed as authors, participated in this study: NRN Steering Committee Chair: Richard A Polin, MD, Division of Neonatology, College of Physicians and Surgeons, Columbia University (2011–present). Alpert Medical School of Brown University and Women & Infants Hospital of Rhode Island (UG1 HD27904)—Abbot R Laptook, MD; Martin Keszler, MD; Angelita M Hensman, PhD RNC-NIC; Elisa Vieira, BSN RN; Lucille St. Pierre, BS. Case Western Reserve University, Rainbow Babies & Children{\textquoteright}s Hospital (UG1 HD21364)—Anna Marie Hibbs, MD; Nancy S Newman, RN; Eileen Stork, MD; Arlene Zadell, RN. Children{\textquoteright}s Mercy Hospital, University of Missouri Kansas City School of Medicine (U10 HD68284)—William E Truog, MD; Eugenia K Pallotto, MD MSCE; Howard W. Kilbride MD; Cheri Gauldin, RN BSN CCRC; Anne Holmes RN MSN MBA-HCM CCRC; Allison Knutson, BSN RNC-NIC.Cincinnati Children{\textquoteright}s Hospital Medical Center, University of Cincinnati Medical Center and Good Samaritan Hospital (UG1 HD27853, UL1 TR77)—Brenda B Poindexter, MD MS; Kurt Schibler, MD; Cathy Grisby, BSN CCRC; Kristin Kirker, CRC. Duke University School of Medicine, University Hospital, University of North Carolina, Duke Regional Hospital and WakeMed Health and Hospitals (UG1 HD40492, UL1 TR1117, UL1 TR1111)—C Michael Cotten, MD MHS; Ronald N Goldberg, MD; Joanne Finkle, RN JD; Kimberley A Fisher, PhD FNP-BC IBCLC; Matthew M Laughon, MD MPH; Carl L Bose, MD; Janice Bernhardt, MS RN; Gennie Bose, RN; Cindy Clark, RN; Stephen D Kicklighter, MD; Ginger Rhodes-Ryan, ARNP MSN, NNP-BC; Jerry Magolan, MD; Jeffery Board, MD. Emory University, Children{\textquoteright}s Healthcare of Atlanta, Grady Memorial Hospital and Emory University Hospital Midtown (UG1 HD27851, UL1 TR454) – David P Carlton, MD; Yvonne Loggins, RN; Colleen Mackie, BS RT; Diane I Bottcher, RN MSN. Eunice Kennedy Shriver National Institute of Child Health and Human Development—Rosemary D Higgins, MD; Stephanie Wilson Archer, MA. Indiana University, University Hospital, Methodist Hospital, Riley Hospital for Children at Indiana University Health and Eskenazi Health (U10 HD27856, UL1 TR6)—Gregory M Sokol, MD; Dianne E Herron, RN CCRC; McGovern Medical School at The University of Texas Health Science Center at Houston, Children{\textquoteright}s Memorial Hermann Hospital and Lyndon Baines Johnson General Hospital/Harris County Hospital District (UG1 HD87229)—Kathleen A Kennedy, MD MPH; Jon E Tyson, MD MPH; Amir M Khan, MD; Emily K Stephens, BSN RNC-NIC; Georgia E McDavid, RN; Claudia I Franco, RNC MSN; Anna E Lis, RN BSN; Sara C Martin, RN BSN; Patricia Ann Orekoya, RN BSN; Claudia Pedrozza, PhD; Patti L Pierce Tate, RCP. Nationwide Children{\textquoteright}s Hospital, The Research Institute at Nationwide Children{\textquoteright}s Hospital, The Ohio State University Wexner Medical Center, The Ohio State College of Medicine, Center for Perinatal Research (U10 HD68278)—Pablo J S{\'a}nchez, MD; Leif D Nelin, MD; Sudarshan R Jadcherla, MD; Patricia Luzader, RN; Erna Clark, BA; Julie Gutentag, RN; Courtney Park, RN; Julie Shadd, BA; Margaret Sullivan, BA; Melanie Stein, BBA, RRT. RTI International (U10 HD36790)—Marie G Gantz, PhD; Carla M Bann, PhD; Dennis Wallace, PhD; Kristin M Zaterka-Baxter, RN BSN CCRP; Jenna Gabrio, BS CCRP; David Leblond, BS; Jeanette O{\textquoteright}Donnell Auman, BS. Stanford University and Lucile Packard Children{\textquoteright}s Hospital (UG1 HD27880, UL1 TR93)—Valerie Y Chock, MD MS Epi; David K Stevenson, MD; M Bethany Ball, BS CCRC; Melinda S Proud, RCP; Elizabeth N Reichert, MA CCRC, Dharshi Sivakumar, MD. University of Alabama at Birmingham Health System and Children{\textquoteright}s Hospital of Alabama (UG1 HD34216)—Waldemar A Carlo, MD; Namasivayam Ambalavanan, MD; Monica V Collins, RN BSN MaEd; Shirley S Cosby, RN BSN. University of California, Los Angeles, Mattel Children{\textquoteright}s Hospital, Santa Monica Hospital, Los Robles Hospital and Medical Center and Olive View Medical Center (U10 HD68270)—Uday Devaskar, MD; Meena Garg, MD; Teresa Chanlaw, MPH; Rachel Geller, RN BSN. University of Iowa and Sanford Health (UG1 HD53109, M01 RR59, UL1 TR442)—Edward F Bell, MD; Tarah T Colaizy, MD MPH; Michelle L Baack, MD; Karen J Johnson, RN BSN; Mendi L Schmelzel, MSN RN; Jacky R Walker, RN; Claire A Goeke, RN; Chelsey Elenkiwich, RN BSN; Megan M Henning, RN; Megan Broadbent, RN BSN; Laurie A Hogden, MD; Jane E Brumbaugh, MD; Jonathan M Klein, MD; John M Dagle, MD PhD. University of New Mexico Health Sciences Center (UG1 HD53089, UL1 TR41)—Janell Fuller, MD; Robin K Ohls, MD; Sandra Sundquist Beauman, MSN RNC-NIC; Conra Backstrom Lacy, RN; Mary Hanson, RN BSN; Elizabeth Kuan, RN BSN. University of Pennsylvania, Hospital of the University of Pennsylvania, Pennsylvania Hospital and Children{\textquoteright}s Hospital of Philadelphia (UG1 HD68244)—Eric C Eichenwald, MD; Barbara Schmidt, MD MSc; Haresh Kirpalani, MB MSc; Aasma S Chaudhary, BS RRT; Soraya Abbasi, MD; Toni Mancini, RN BSN CCRC; Sarvin Ghavam, MD; Jonathan Snyder, RN BSN; Christine Catts, CRNP. University of Rochester Medical Center, Golisano Children{\textquoteright}s Hospital and the University at Buffalo John R. Oishei Children{\textquoteright}s Hospital of Buffalo (UG1 HD68263, UL1 TR42)—Carl T D{\textquoteright}Angio, MD; Ronnie Guillet, MD PhD; Anne Marie Reynolds, MD MPH; Satyan Lakshminrusimha, MD; Holly I M Wadkins, MA; Michael G Sacilowski, MAT CCRC; Mary Rowan, RN; Rosemary Jensen; Dee Maffett, RN; Diane Prinzing, AAS; Ann Marie Scorsone, MS CCRC; Kyle Binion, BS; Stephanie Guilford, BS; Constance Orme; Premini Sabaratnam, MPH; Daisy Rochez, BS MHA. University of Texas Southwestern Medical Center, Parkland Health & Hospital System, and Children{\textquoteright}s Medical Center Dallas (UG1 HD40689)—Myra Wyckoff, MD; Luc P Brion, MD; Maria M DeLeon, RN BSN; Frances Eubanks, RN BSN; Pollieanna Sepulvida, RN; Diana M Vasil, MSN RNC-NIC BSN. University of Utah Medical Center, Intermountain Medical Center, McKay-Dee Hospital, Utah Valley Hospital, and Primary Children{\textquoteright}s Medical Center (UG1 HD87226, UL1 TR105)—Bradley A Yoder, MD; Mariana Baserga, MD MSCI; Stephen D Minton, MD; Mark J Sheffield, MD; Carrie A Rau, RN BSN CCRC; Jill Burnett, RNC BSN; Brandy Davis, RN; Susan Christensen, RN; Manndi C Loertscher, BS CCRP; Trisha Marchant, RNC; Earl Maxson, RN CCRN; Kandace McGrath; Jennifer O Elmont, RN BSN; Melody Parry, RN; Susan T Schaefer, RN, BSN, RRT; Kimberlee Weaver-Lewis, RN MS; Kathryn D Woodbury, RN BSN. Publisher Copyright: {\textcopyright} ",

year = "2021",

month = jan,

day = "1",

doi = "10.1136/archdischild-2019-318710",

language = "English (US)",

volume = "106",

pages = "62--68",

journal = "Archives of Disease in Childhood: Fetal and Neonatal Edition",

issn = "1359-2998",

publisher = "BMJ Publishing Group",

number = "1",

}

TY - JOUR

T1 - Placental transfusion and short-term outcomes among extremely preterm infants

AU - Kumbhat, Neha

AU - Eggleston, Barry

AU - Davis, Alexis S.

AU - Van Meurs, Krisa P.

AU - Demauro, Sara Bonamo

AU - Foglia, Elizabeth E.

AU - Lakshminrusimha, Satyanarayan

AU - Walsh, Michele C.

AU - Watterberg, Kristi L.

AU - Wyckoff, Myra H.

AU - Das, Abhik

AU - Handley, Sara C.

N1 - Funding Information: 1Neonatology, Fetal and Neonatal Institute, Division of Neonatology, Children’s Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California, USA 2Division of Neonatology, Lucile Packard Children’s Hospital, Palo Alto, California, USA 3Biostatistics and Epidemiology, RTI International, Research Triangle Park, North Carolina, USA 4Department of Pediatrics, Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA 5UC Davis, Davis, California, USA 6Pediatrics, Case Western Reserve University, Cleveland, Ohio, USA 7Department of Paediatrics, University of New Mexico, Albuquerque, New Mexico, USA 8Pediatrics, UT Southwestern Medical Center at Dallas, Dallas, Texas, USA 9RTI International, Rockville, Maryland, USA Acknowledgements The authors acknowledge the National Institutes of Health, the Eunice Kennedy Shriver NICHD and the National Center for Advancing Translational Sciences (NCATS) for providing grant support for the NRN’s GDB Study through cooperative agreements. While NICHD staff had input into the study design, conduct, analysis and manuscript drafting, the comments and views of the authors do not necessarily represent the views of NICHD, the National Institutes of Health, the Department of Health and Human Services or the US Government. Participating NRN sites collected data and transmitted it to RTI International, the data coordinating center (DCC) for the network, which stored, managed and analysed the data for this study. On behalf of the NRN, RTI International had full access to all of the data in the study, and with the NRN Center Principal Investigators, takes responsibility for the integrity of the data and accuracy of the data analysis. We are indebted to our medical and nursing colleagues and the infants and their parents who agreed to take part in this study. The following investigators, in addition to those listed as authors, participated in this study: NRN Steering Committee Chair: Richard A Polin, MD, Division of Neonatology, College of Physicians and Surgeons, Columbia University (2011–present). Alpert Medical School of Brown University and Women & Infants Hospital of Rhode Island (UG1 HD27904)—Abbot R Laptook, MD; Martin Keszler, MD; Angelita M Hensman, PhD RNC-NIC; Elisa Vieira, BSN RN; Lucille St. Pierre, BS. Case Western Reserve University, Rainbow Babies & Children’s Hospital (UG1 HD21364)—Anna Marie Hibbs, MD; Nancy S Newman, RN; Eileen Stork, MD; Arlene Zadell, RN. Children’s Mercy Hospital, University of Missouri Kansas City School of Medicine (U10 HD68284)—William E Truog, MD; Eugenia K Pallotto, MD MSCE; Howard W. Kilbride MD; Cheri Gauldin, RN BSN CCRC; Anne Holmes RN MSN MBA-HCM CCRC; Allison Knutson, BSN RNC-NIC.Cincinnati Children’s Hospital Medical Center, University of Cincinnati Medical Center and Good Samaritan Hospital (UG1 HD27853, UL1 TR77)—Brenda B Poindexter, MD MS; Kurt Schibler, MD; Cathy Grisby, BSN CCRC; Kristin Kirker, CRC. Duke University School of Medicine, University Hospital, University of North Carolina, Duke Regional Hospital and WakeMed Health and Hospitals (UG1 HD40492, UL1 TR1117, UL1 TR1111)—C Michael Cotten, MD MHS; Ronald N Goldberg, MD; Joanne Finkle, RN JD; Kimberley A Fisher, PhD FNP-BC IBCLC; Matthew M Laughon, MD MPH; Carl L Bose, MD; Janice Bernhardt, MS RN; Gennie Bose, RN; Cindy Clark, RN; Stephen D Kicklighter, MD; Ginger Rhodes-Ryan, ARNP MSN, NNP-BC; Jerry Magolan, MD; Jeffery Board, MD. Emory University, Children’s Healthcare of Atlanta, Grady Memorial Hospital and Emory University Hospital Midtown (UG1 HD27851, UL1 TR454) – David P Carlton, MD; Yvonne Loggins, RN; Colleen Mackie, BS RT; Diane I Bottcher, RN MSN. Eunice Kennedy Shriver National Institute of Child Health and Human Development—Rosemary D Higgins, MD; Stephanie Wilson Archer, MA. Indiana University, University Hospital, Methodist Hospital, Riley Hospital for Children at Indiana University Health and Eskenazi Health (U10 HD27856, UL1 TR6)—Gregory M Sokol, MD; Dianne E Herron, RN CCRC; McGovern Medical School at The University of Texas Health Science Center at Houston, Children’s Memorial Hermann Hospital and Lyndon Baines Johnson General Hospital/Harris County Hospital District (UG1 HD87229)—Kathleen A Kennedy, MD MPH; Jon E Tyson, MD MPH; Amir M Khan, MD; Emily K Stephens, BSN RNC-NIC; Georgia E McDavid, RN; Claudia I Franco, RNC MSN; Anna E Lis, RN BSN; Sara C Martin, RN BSN; Patricia Ann Orekoya, RN BSN; Claudia Pedrozza, PhD; Patti L Pierce Tate, RCP. Nationwide Children’s Hospital, The Research Institute at Nationwide Children’s Hospital, The Ohio State University Wexner Medical Center, The Ohio State College of Medicine, Center for Perinatal Research (U10 HD68278)—Pablo J Sánchez, MD; Leif D Nelin, MD; Sudarshan R Jadcherla, MD; Patricia Luzader, RN; Erna Clark, BA; Julie Gutentag, RN; Courtney Park, RN; Julie Shadd, BA; Margaret Sullivan, BA; Melanie Stein, BBA, RRT. RTI International (U10 HD36790)—Marie G Gantz, PhD; Carla M Bann, PhD; Dennis Wallace, PhD; Kristin M Zaterka-Baxter, RN BSN CCRP; Jenna Gabrio, BS CCRP; David Leblond, BS; Jeanette O’Donnell Auman, BS. Stanford University and Lucile Packard Children’s Hospital (UG1 HD27880, UL1 TR93)—Valerie Y Chock, MD MS Epi; David K Stevenson, MD; M Bethany Ball, BS CCRC; Melinda S Proud, RCP; Elizabeth N Reichert, MA CCRC, Dharshi Sivakumar, MD. University of Alabama at Birmingham Health System and Children’s Hospital of Alabama (UG1 HD34216)—Waldemar A Carlo, MD; Namasivayam Ambalavanan, MD; Monica V Collins, RN BSN MaEd; Shirley S Cosby, RN BSN. University of California, Los Angeles, Mattel Children’s Hospital, Santa Monica Hospital, Los Robles Hospital and Medical Center and Olive View Medical Center (U10 HD68270)—Uday Devaskar, MD; Meena Garg, MD; Teresa Chanlaw, MPH; Rachel Geller, RN BSN. University of Iowa and Sanford Health (UG1 HD53109, M01 RR59, UL1 TR442)—Edward F Bell, MD; Tarah T Colaizy, MD MPH; Michelle L Baack, MD; Karen J Johnson, RN BSN; Mendi L Schmelzel, MSN RN; Jacky R Walker, RN; Claire A Goeke, RN; Chelsey Elenkiwich, RN BSN; Megan M Henning, RN; Megan Broadbent, RN BSN; Laurie A Hogden, MD; Jane E Brumbaugh, MD; Jonathan M Klein, MD; John M Dagle, MD PhD. University of New Mexico Health Sciences Center (UG1 HD53089, UL1 TR41)—Janell Fuller, MD; Robin K Ohls, MD; Sandra Sundquist Beauman, MSN RNC-NIC; Conra Backstrom Lacy, RN; Mary Hanson, RN BSN; Elizabeth Kuan, RN BSN. University of Pennsylvania, Hospital of the University of Pennsylvania, Pennsylvania Hospital and Children’s Hospital of Philadelphia (UG1 HD68244)—Eric C Eichenwald, MD; Barbara Schmidt, MD MSc; Haresh Kirpalani, MB MSc; Aasma S Chaudhary, BS RRT; Soraya Abbasi, MD; Toni Mancini, RN BSN CCRC; Sarvin Ghavam, MD; Jonathan Snyder, RN BSN; Christine Catts, CRNP. University of Rochester Medical Center, Golisano Children’s Hospital and the University at Buffalo John R. Oishei Children’s Hospital of Buffalo (UG1 HD68263, UL1 TR42)—Carl T D’Angio, MD; Ronnie Guillet, MD PhD; Anne Marie Reynolds, MD MPH; Satyan Lakshminrusimha, MD; Holly I M Wadkins, MA; Michael G Sacilowski, MAT CCRC; Mary Rowan, RN; Rosemary Jensen; Dee Maffett, RN; Diane Prinzing, AAS; Ann Marie Scorsone, MS CCRC; Kyle Binion, BS; Stephanie Guilford, BS; Constance Orme; Premini Sabaratnam, MPH; Daisy Rochez, BS MHA. University of Texas Southwestern Medical Center, Parkland Health & Hospital System, and Children’s Medical Center Dallas (UG1 HD40689)—Myra Wyckoff, MD; Luc P Brion, MD; Maria M DeLeon, RN BSN; Frances Eubanks, RN BSN; Pollieanna Sepulvida, RN; Diana M Vasil, MSN RNC-NIC BSN. University of Utah Medical Center, Intermountain Medical Center, McKay-Dee Hospital, Utah Valley Hospital, and Primary Children’s Medical Center (UG1 HD87226, UL1 TR105)—Bradley A Yoder, MD; Mariana Baserga, MD MSCI; Stephen D Minton, MD; Mark J Sheffield, MD; Carrie A Rau, RN BSN CCRC; Jill Burnett, RNC BSN; Brandy Davis, RN; Susan Christensen, RN; Manndi C Loertscher, BS CCRP; Trisha Marchant, RNC; Earl Maxson, RN CCRN; Kandace McGrath; Jennifer O Elmont, RN BSN; Melody Parry, RN; Susan T Schaefer, RN, BSN, RRT; Kimberlee Weaver-Lewis, RN MS; Kathryn D Woodbury, RN BSN. Publisher Copyright: ©

PY - 2021/1/1

Y1 - 2021/1/1

N2 - Objective To compare short-term outcomes after placental transfusion (delayed cord clamping (DCC) or umbilical cord milking (UCM)) versus immediate cord clamping among extremely preterm infants. Design Retrospective study. Setting The Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network registry. Patients Infants born <29 weeks' gestation in 2016 or 2017 without congenital anomalies who received active treatment after delivery. Intervention/exposure DCC or UCM. Main outcome measures Primary outcomes: (1) composite of mortality or major morbidity by 36 weeks' postmenstrual age (PMA); (2) mortality by 36 weeks PMA and (3) composite of major morbidities by 36 weeks' PMA. Secondary composite outcomes: (1) any grade intraventricular haemorrhage or mortality by 36 weeks' PMA and (2) hypotension treatment in the first 24 postnatal hours or mortality in the first 12 postnatal hours. Outcomes were assessed using multivariable regression, adjusting for mortality risk factors identified a priori, significant confounders and centre as a random effect. Results Among 3116 infants, 40% were exposed to placental transfusion, which was not associated with the primary composite outcome of mortality or major morbidity by 36 weeks' PMA (adjusted OR (aOR) 1.26, 95% CI 0.95 to 1.66). However, exposure was associated with decreased mortality by 36 weeks' PMA (aOR 0.71, 95% CI 0.55 to 0.92) and decreased hypotension treatment in first 24 postnatal hours (aOR 0.66, 95% CI 0.53 to 0.82). Conclusion In this extremely preterm infant cohort, exposure to placental transfusion was not associated with the composite outcome of mortality or major morbidity, though there was a reduction in mortality by 36 weeks' PMA. Trial registration number NCT00063063.

AB - Objective To compare short-term outcomes after placental transfusion (delayed cord clamping (DCC) or umbilical cord milking (UCM)) versus immediate cord clamping among extremely preterm infants. Design Retrospective study. Setting The Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network registry. Patients Infants born <29 weeks' gestation in 2016 or 2017 without congenital anomalies who received active treatment after delivery. Intervention/exposure DCC or UCM. Main outcome measures Primary outcomes: (1) composite of mortality or major morbidity by 36 weeks' postmenstrual age (PMA); (2) mortality by 36 weeks PMA and (3) composite of major morbidities by 36 weeks' PMA. Secondary composite outcomes: (1) any grade intraventricular haemorrhage or mortality by 36 weeks' PMA and (2) hypotension treatment in the first 24 postnatal hours or mortality in the first 12 postnatal hours. Outcomes were assessed using multivariable regression, adjusting for mortality risk factors identified a priori, significant confounders and centre as a random effect. Results Among 3116 infants, 40% were exposed to placental transfusion, which was not associated with the primary composite outcome of mortality or major morbidity by 36 weeks' PMA (adjusted OR (aOR) 1.26, 95% CI 0.95 to 1.66). However, exposure was associated with decreased mortality by 36 weeks' PMA (aOR 0.71, 95% CI 0.55 to 0.92) and decreased hypotension treatment in first 24 postnatal hours (aOR 0.66, 95% CI 0.53 to 0.82). Conclusion In this extremely preterm infant cohort, exposure to placental transfusion was not associated with the composite outcome of mortality or major morbidity, though there was a reduction in mortality by 36 weeks' PMA. Trial registration number NCT00063063.

KW - epidemiology

KW - mortality

KW - neonatology

KW - outcomes research

KW - procedures

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UR - http://www.scopus.com/inward/citedby.url?scp=85097833697&partnerID=8YFLogxK

U2 - 10.1136/archdischild-2019-318710

DO - 10.1136/archdischild-2019-318710

M3 - Article

C2 - 32732380

AN - SCOPUS:85097833697

SN - 1359-2998

VL - 106

SP - 62

EP - 68

JO - Archives of Disease in Childhood: Fetal and Neonatal Edition

JF - Archives of Disease in Childhood: Fetal and Neonatal Edition

IS - 1

ER -

Placental transfusion and short-term outcomes among extremely preterm infants

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