Periventricular/intraventricular hemorrhage following early and delayed umbilical cord clamping. A randomized controlled trial

Abstract

Objective: To test the hypothesis that early compared with delayed clamping of the umbilical cords of low-birthweight babies may increase the incidence of periventricular/intraventricular hemorrhage (PVH/IVH).

Design: Randomized controlled trial.

Setting: The labor wards of 3 teaching hospitals of the University of the Witwatersrand, Johannesburg.

Patients: Women expected to give birth to babies weighing less than 2000 g.

Interventions: Allocation by randomly ordered, sealed cards to a policy either of clamping the umbilical cord immediately after delivery, or, if possible, delaying cord clamping for 1 to 2 min.

Main outcome measures: Ultrasound diagnosis of PVH/IVH about 24 h after birth by an observer blind to the allocation of each patient.

Results: PVH/IVH was diagnosed in 8/40 (20%) of neonates following delayed umbilical cord clamping and 11/46 (24%) following early cord clamping (odds ratio 0.80; 95% confidence interval, 0.29 to 2.20).

Conclusions: This study does not confirm that early clamping of the umbilical cord may contribute to the initiation of PVH/IVH in low-birthweight neonates, but further studies are required before the hypothesis can be rejected with confidence.