PC1043: Short-term and Long-term Outcomes in Term Infants Exposed to Delayed Cord Clamping

Background: AAP, ACOG and NRP have recommended delayed cord clamping (DCC) in term and preterm deliveries. DCC has established short and long-term benefits. Studies have shown that DCC in term infants is associated with improved hematologic status, neurodevelopmental outcomes, and decreased risk of iron deficiency anemia. The purpose of this study is to compare short-term and long-term outcomes of term infants exposed to either immediate (ICC) or delayed cord clamping (DCC).

Methods: Retrospective study of term infants born at LAC+USC Medical Center and exposed to delayed or immediate cord clamping between 2016-2019. Demographics, clinical data, duration of cord clamping, and neurodevelopmental outcomes were collected from electronic medical records and paper charts. Infants with ABO incompatibility were excluded. Ages and stages questionnaire (ASQ) was used to assess communication, gross and fine motor, problem solving and social skills at 9-12 months and 18-24 months of age. Data was analyzed with two sample T test, Chi Square test, and logistic regression.

Results: There were 333 infants included in the study, however only 122/333 (37%) and 146/333 (44%) were assessed for neurodevelopmental outcomes at 9-12 months and 18-24 months of age respectively. Demographics and temperature on admission were not different between groups. Hemoglobin level within 96 hours of life, rate phototherapy during birth admission and rate of readmission for phototherapy were significantly higher in the DCC group (Table 1). This association persisted after adjustment of type of feeding in a regression model. The odds of infants exposed to phototherapy [OR=2.62 (95% CI; 1.36-5.01 p= < 0.01] and readmitted for phototherapy [OR=3.05 (95% CI; 1.06-8.73) p=0.04] were significantly higher in the DCC group. Mean hemoglobin level at 9-12 months of age [12.2 (±0.9) vs. 12.3 ((±0.97) p=0.34] and neurodevelopmental scores in any domains of ASQ at 9-12 and 18-24 months of age were not significantly different between groups (Table 2). There was no difference in the rate of infants who received iron supplementation. No infants received blood transfusion in either group.

Conclusion: Our preliminary data showed that DCC in term infants resulted in higher hemoglobin level at 96 hours of age and 3 times higher rate of exposure to phototherapy during birth admission and readmission for phototherapy. However, neurodevelopmental scores at 9-12 months and 18-24 months of age were similar in both ICC and DCC groups. Bilirubin levels in term infants exposed to DCC need to be closely monitored. These results need to be verified in a larger sample size.