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Effect of delayed cord clamping on stem cell transfusion and hematological parameters in preterm infants with placental insufficiency: a pilot randomized trial

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A Correction to this article was published on 04 July 2022

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Abstract

The feasibility of delayed cord clamping (DCC) in preterm infants with placental insufficiency (PI) is questionable. We aimed to study the effect of DCC on stem cell transfusion, hematological parameters, and clinical outcomes in preterm infants born to mothers with PI. Preterm infants, < 34 weeks’ gestation, born to mothers with PI were randomized based on the timing of umbilical cord clamping into delayed clamping for 60 s (DCC group) or immediate cord clamping (ICC group) groups at time of birth. CD34 percentage as a marker of stem cell transfusion, early and late-onset anemia, hypothermia, hypotension, polycythemia, hyperbilirubinemia, duration of oxygen therapy, bronchopulmonary dysplasia, intra-ventricular hemorrhage, necrotizing enterocolitis, sepsis, mortality, and length of hospital stay were compared between studied groups. We found that peripheral blood CD34 percentage was significantly higher in DCC compared with that in the ICC group (median (IQR) of 0.5 (0.40–0.7) versus 0.35 (0.20–0.5), p = 0.004). Infants in the DCC group had significantly lower episodes of anemia of prematurity at 2 months, red blood cell transfusion, and shorter duration of oxygen therapy compared with those in the ICC group.

Conclusion: In conclusion, DCC compared with ICC increased stem cell transfusion and decreased early- and late-onset anemia in preterm infants with placental insufficiency.

Trial registration: NCT03731546 www.clinicaltrials.gov

What is Known:

• Delayed cord clamping has been recommended by the American Academy of Pediatrics as a standard of care practice during delivery of preterm infants.

• The feasibility of DCC in preterm infants with placental insufficiency (PI) is uncertain.

What is New:

• This randomized controlled trial demonstrated that DCC in the delivery room care of preterm infants born to mothers with placental insufficiency increased stem cell transfusion and decreased early- and late-onset anemia.

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Abbreviations

BPD:

Bronchopulmonary dysplasia

CPAP:

Continuous positive airway pressure

DCC:

Delayed cord clamping

DCC+NP:

Delayed cord clamping and normal placenta

DCC+PI:

Delayed cord clamping and placental insufficiency

ICC:

Immediate cord clamping

ICC+PI:

Immediate cord clamping and placental insufficiency

ELBW:

Extreme low birth weight infant

IUGR:

Intrauterine growth retardation

NEC:

Necrotizing enterocolitis

NICU:

Neonatal intensive care unit

SGA:

Small for gestational age

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Acknowledgments

We would like to thank Miss Eitemad Arafaa for her effort in randomization and allocation of infants into study groups. We would like to thank the parents and families in the Neonatal Intensive Care Unit at Mansoura University Children’s Hospital.

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Authors and Affiliations

  1. Neonatal Intensive Care Unit, Department of Pediatrics, Mansoura University Children’s Hospital, Gomhoria Street, Mansoura, 35516, Egypt

    Mohammed Yunis, Islam Nour, Basma Shouman & Nehad Nasef

  2. Department of Pediatrics, Faculty of Medicine, University of Mansoura, Mansoura, Egypt

    Islam Nour, Mohamed Sarhan, Basma Shouman & Nehad Nasef

  3. Department of Obstetrics and Gynecology, Faculty of Medicine, University of Mansoura, Mansoura, Egypt

    Ahmed Gibreel

  4. Department of Clinical Pathology, Faculty of Medicine, University of Mansoura, Mansoura, Egypt

    Mohamad Darwish

  5. Hematology and Oncology Unit, Mansoura University Children’s Hospital, Mansoura, Egypt

    Mohamed Sarhan

Authors
  1. Mohammed Yunis
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  2. Islam Nour
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  3. Ahmed Gibreel
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  4. Mohamad Darwish
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  7. Nehad Nasef
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Contributions

Mohammed Yunis participated in design of the study, data collection and writing the first draft of the manuscript. Nehad Nasef and Islam Nour participated in formulating the hypothesis, design of the study, data collection, data interpretation, statistical analysis, and writing of the manuscript. Basma Shouman and Mohamed Sarhan participated in design of the study, data collection, and writing of the manuscript. Ahmed Gibreel participated in design of the study, supervising the delayed cord clamping practice, obstetric data collection, data interpretation and writing the manuscript. Mohamad Darwish participated in laboratory analysis, data interpretation, and writing of the manuscript. All authors approved the final version of the manuscript.

Corresponding author

Correspondence to Nehad Nasef.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article has been approved by the local Medical Research Ethics Committee of Faculty of Medicine, University of Mansoura, Egypt.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Communicated by Daniele De Luca

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Yunis, M., Nour, I., Gibreel, A. et al. Effect of delayed cord clamping on stem cell transfusion and hematological parameters in preterm infants with placental insufficiency: a pilot randomized trial. Eur J Pediatr 180, 157–166 (2021). https://doi.org/10.1007/s00431-020-03730-4

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  • DOI: https://doi.org/10.1007/s00431-020-03730-4

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