• Himanshu Popat, Kristy P Robledo, Lucille Sebastian, Nicholas Evans, Andrew Gill, Martin Kluckow, Sanjay Sinhal, Koert de Waal, William Tarnow-Mordi, and David Osborn.
• Department of Neonatology, Children's Hospital at Westmead, New South Wales, Australia; University of Sydney, Sydney, New South Wales, Australia.
• J. Pediatr. 2016 Nov 1; 178: 81-86.e2.

ObjectiveTo determine whether delayed cord clamping improves systemic blood flow compared with immediate cord clamping in very preterm infants in the first 24 hours.Study DesignWomen delivering at <30 weeks' gestation at 5 tertiary centers were randomized to receive immediate cord clamping (<10 seconds) or delayed cord clamping (≥60 seconds). Echocardiography and cardiorespiratory data were collected at 3, 9, and 24 hours after birth. The primary outcome was mean lowest superior vena cava (SVC) flow.ResultsOf 266 infants enrolled, 133 were randomized to immediate cord clamping and 133 to delayed cord clamping. The 2 groups were similar at baseline, including mean gestation (immediate cord clamping 28 weeks vs delayed cord clamping 28 weeks) and birth weight (immediate cord clamping 1003 g vs delayed cord clamping 1044 g). There was no significant difference between groups in the primary outcome of mean lowest SVC flow (immediate cord clamping 71.4 mL/kg/min [SD 28.1] vs delayed cord clamping 70.2 mL/kg/min [SD 26.9]; P = .7). For secondary outcomes, hemoglobin increased by 0.9 g/dL at 6 hours in the group with delayed cord clamping (95% CI 3.9, 14.4; P = .0005, adjusted for baseline). The group with delayed cord clamping had lower right ventricular output (-21.9 mL/kg/min, 95% CI -39.0, -4.7; P = .01). Rates of treated hypotension, ductus arteriosus size and shunt direction, and treatment of the ductus arteriosus were similar.ConclusionsDelayed cord clamping had no effect on systemic blood flow measured as mean lowest SVC flow in the first 24 hours in infants <30 weeks' gestation.Trial RegistrationAustralia New Zealand Clinical Trials Registry: ACTRN12610000633088.Copyright © 2016 Elsevier Inc. All rights reserved.

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