APTS
Trial question
Is delayed cord clamping superior to immediate cord clamping in preterm infants?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
44.0% female
56.0% male
N = 1566
1566 patients (683 female, 883 male)
Inclusion criteria: fetuses from women who were expected to deliver before 30 weeks of gestation
Key exclusion criteria: fetal hemolytic disease; hydrops fetalis; twin-twin transfusion; genetic syndromes; potentially lethal malformations
Interventions
N=784 delayed cord clamping (≥ 60 seconds after delivery)
N=782 immediate cord clamping (≤ 10 seconds after delivery)
Primary outcome
Death or major morbidity at 36 weeks of postmenstrual age
37
37.2
37.2 %
27.9 %
18.6 %
9.3 %
0.0 %
Delayed cord clamping
Immediate cord clamping
No significant difference ↔
No significant difference in death or major morbidity at 36 weeks of postmenstrual age (37% vs. 37.2%; RR 1, 95% CI 0.88 to 1.13)
Secondary outcomes
Significant decrease in death at 36 weeks (6.4% vs. 9%; RR 0.69, 95% CI 0.49 to 0.97)
No significant difference in death or severe brain injury (13.6% vs. 15.3%; RR 0.85, 95% CI 0.67 to 1.08)
No significant difference in chronic lung disease (54.4% vs. 51.6%; RR 1.04, 95% CI 0.95 to 1.14)
Conclusion
In fetuses from women who were expected to deliver before 30 weeks of gestation, delayed cord clamping was not superior to immediate cord clamping with respect to death or major morbidity at 36 weeks of postmenstrual age.
Reference
William Tarnow-Mordi, Jonathan Morris, Adrienne Kirby et al. Delayed versus Immediate Cord Clamping in Preterm Infants. N Engl J Med. 2017 Dec 21;377(25):2445-2455.
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