800 - Umbilical Cord Management Among Higher-Risk Pregnancies

Poster Number: 800
Publication Number: 800.249

Chelsea Bitler, Nationwide Children's Hospital, Columbus, OH, United States; Brian Rivera, The Abigail Wexner Research Institute at Nationwide Children's Hospital, COLUMBUS, OH, United States; Carl Backes, Nationwide Children's Hospital, Columbus, OH, United States

Background: Clamping and cutting the umbilical cord at birth occurs for each of the 140 million neonates born annually. The American Academy of Pediatrics (AAP) endorses delayed cord clamping (DCC), rather than early cord clamping (ECC), in uncomplicated pregnancies. However, higher-risk pregnancies have been largely excluded from randomized clinical trials (RCTs) based on concerns that DCC may worsen neonatal outcomes, including increasing the risk for polycythemia (hematocrit >65%). In turn, the AAP has identified the critical need for data to guide evidence-based cord clamping practices among higher-risk pregnancies.

Objective: The primary objective was to assess the nature and extent of contemporary (2012-2022) data on optimal cord clamping practices among higher-risk, complicated pregnancies.

Design/Methods: MEDLINE (PubMed) was searched (2012-2022), restricted to English language manuscripts. Publications including preterm and term gestation infants and mothers comparing DCC, ECC, and umbilical cord milking (UCM) were considered. Data extraction was independently performed by multiple observers with outcomes agreed upon a-priori. A consensus decision was made prior to data abstraction to combine SGA and IUGR into one subgroup. Data were pooled using a random effects model with incidence of polycythemia (hematocrit >65%) as the primary outcome of interest.

Results: One-hundred and twelve studies of 20,653 subjects were included. Studies were highly diverse with regards to the participants, interventions, and outcomes reported. Available evidence on cord-clamping practices among higher-risk maternal-infant groups is shown in Table 1. Pooled near-term and term data demonstrated a significant increased relative risk (RR) of polycythemia among SGA/IUGR infants receiving DCC versus ECC (Figure 1). However, no differences were observed in symptomatic polycythemia (RR 2.39, CI:0.36-16.01; p=0.37). Similarly, we observed no differences in peak serum bilirubin, need for phototherapy, or respiratory distress among higher-risk subgroups receiving DCC versus ECC. Trials involving UCM were not pooled due to lack of available outcomes data for groups of interest.

Conclusion(s): The present study identifies sources of variability across RCTs that evaluate umbilical cord clamping practices and reinforces the critical need for consistent and transparent policies governing eligibility criteria. Additional studies are needed to guide healthcare providers as to best cord management strategies among higher-risk pregnancies.