Oral or Poster Presentation
Concurrent Session 4D - Maternal Fetal Medicine
Introduction: A recent meta-analysis found a 30% decrease in mortality in extremely preterm infants randomized to receive deferred cord clamping (DCC). There is paucity of data on DCC in twins. Our primary objective was to determine whether DCC was associated with reduction in death before discharge and/or serious neurological injury in survivors to discharge (SNI) in twins ≤29+6 weeks.
Methods: We conducted a retrospective study using the Canadian Neonatal/Preterm Birth Network database. We included twins ≤29+6 weeks and compared DCC ≥30 seconds to immediate cord clamping (ICC) <30 seconds. Our primary outcome was a composite of death and/or SNI (IVH-intraventricular hemorrhage grade III/IV and PVL-periventricular leukomalacia), with a complete set of secondary outcomes. We calculated adjusted odds ratios (aOR) and coefficients for categorical and continuous variables, respectively, and 95% confidence intervals (CI). Models were fitted with generalized estimated equations to account for clustering.
Results: We included 1597 infants from twin pairs whereby 624 (39.1%) twins received DCC and 973 (60.9%) twins received ICC. Death/SNI occurred in 17.8% (N=111) of twins who received DCC and in 21.7% (N=211) of twins who received ICC. Between twins who received DCC versus ICC, we did not find a significant difference in death/SNI (aOR 1.07, 95% CI 0.78-1.47). We did find that DCC was associated with significant decrease in need for mechanical ventilation (aOR 0.51, 95% CI 0.39-0.67), delivery room intubations (aOR 0.53, 95% CI 0.42-0.68), transfusions (coefficient -0.49, 95% CI -0.86, -0.12) and NICU length of stay (coefficient -4.17, 95% CI -8.15, -0.19).
Conclusion: Deferred cord clamping was not associated with a significant reduction in death before discharge and/or severe neurological injury in twins ≤29+6 weeks, but was associated with reduction in mechanical ventilation, delivery room intubations, transfusions and NICU length of stay.