215 - Delayed cord clamping is not associated with decreased acute kidney injury in extremely premature neonates; a secondary Preterm Erythropoietin Neuroprotection Trial analysis

Saturday, April 29, 2023

3:30 PM – 6:00 PM ET

Poster Number: 215
Publication Number: 215.242

Henry Zapata, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; Namrata Todurkar, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada; Kristen Favel, University of California, San Francisco, School of Medicine, San Francisco, CA, United States; Jennifer R. Charlton, University of Virginia, Charlottesville, VA, United States; Tapas Kulkarni, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada; Ryan McAdams, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States; Michelle C. Starr, Indiana University School of Medicine, Indinapolis, IN, United States; Cherry Mammen, BC Children's Hospital, Vancouver, BC, Canada; Matthew Harer, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States

Presenting Author(s)

HZ

Henry Zapata Galarza, MD

Fellow
University of Wisconsin School of Medicine and Public Health
Madison, Wisconsin, United States

Background: Delayed cord clamping (DCC) is associated with reduced mortality compared with early cord clamping (ECC). Improved hemodynamics and hematologic indices associated with DCC may improve neonatal kidney perfusion and oxygenation. A previous single-center cohort study in very low birth weight neonates showed no difference in acute kidney injury (AKI) between groups (DCC, ECC).

Objective: We hypothesized that in a larger multicenter study with prospectively collected data in a more premature population, DCC would be associated with reduced AKI in extremely low gestational age neonates (24-27 6/7 weeks gestation).

Design/Methods: We performed a secondary analysis of the Preterm Erythropoietin Neuroprotection Trial (PENUT, n=936). We included participants if umbilical cord management data were recorded. Exposure: DCC defined as cord clamping ≥30 seconds after delivery. Primary outcome: AKI in NICU by KDIGO definition based on serum creatinine only. Secondary outcome: severe (Stage 2 or 3), early (days 3-7), or late ( >7 days) AKI. We used a generalized estimating equation logistic regression model to evaluate in-hospital AKI outcomes between groups.

Results: Cord management data was recorded in 675 (72%) neonates (DCC n=316, ECC n=359). Demographics Table 1. Gestational age and sex did not differ between groups, while birthweight was higher in the DCC compared with ECC group (821 v. 789g, p=0.02). DCC was performed less frequently in Black mothers compared to white mothers (33 vs. 53%, p< 0.01. Hispanic mothers were more likely to have DCC compared to non-Hispanic mothers (64 vs. 42 %, p< 0.01). Any AKI occurred in 45% and severe AKI in 23% of participants. There were no differences in crude rates of any, severe, early, or late AKI between DCC and ECC groups (Table 2). After adjusting for maternal race and ethnicity, Apgar scores, delivery room resuscitation, antenatal steroid use, vasopressor, and NSAID exposure, no differences in AKI rates were identified (aOR 1.19 [95%CI 0.79-1.8]), Table 3).

Conclusion(s):

We found no evidence that DCC was associated with decreased rates or severity of AKI as measured by changes in serum creatinine, suggesting that the effects of DCC on hemodynamic and hematologic indices in preterm infants may have limited effect on immediate postnatal kidney function and pathophysiology. Future studies could evaluate other markers of kidney injury, including urine output and urinary biomarkers.