(32) The Impact of Delayed Cord Clamping on Neonatal Outcomes Following Fetal Chorioamnionitis

Claire D. Murray, SSM Cardinal Glennon Children's Medical Center, Saint Louis, MO, United States; Amit Mathur, SSM Cardinal Glennon Children's Hospital, United States; Zidong Zhang, St Louis University, United States

Background: In preterm infants, delayed umbilical cord clamping (DCC) is associated with significant neonatal benefits including improved transitional circulation, better establishment of red blood cell volume, decreased need for blood transfusion, and lower incidence of necrotizing enterocolitis and intraventricular hemorrhage (IVH). Despite the known benefits of DCC, there are only a few studies that have evaluated risk factors that may blunt the impact of DCC on outcomes.

Objectives: This study aims to evaluate the modulating effect of DCC on infant mortality and short-term outcomes in premature infants born following exposure to fetal inflammatory response histologic chorioamnionitis (FIR-HCA).

Design/Methods: In this retrospective cohort study, premature infants < 32 weeks who underwent DCC were grouped into exposed to FIR-HCA or not-exposed to any HCA. The primary outcome was mortality while secondary outcomes included admission hemoglobin, need for inotropes, need for invasive ventilation on day-of-life 7, intraventricular hemorrhage (IVH) and necrotizing enterocolitis.

Results: 426 infants who underwent DCC were included (FIR-HCA n= 139), (no-HCA n= 287). Demographic factors were similar between groups. Compared to infants who were not exposed to HCA, infants who were exposed to FIR-HCA had a significantly lower risk of mortality, no difference in IVH rates and less need for invasive ventilation, despite a lower initial hemoglobin level.

Conclusion: DCC is associated with improved survival and improved neonatal morbidity in the setting of FIR-HCA. These benefits are not mediated through increased red cell mass.