Antenatal prediction of early cord clamping among infants born extremely preterm

Abstract

OBJECTIVE: To identify prenatal risk factors associated with early cord clamping (ECC) in extremely infants born extremely preterm (22-28 weeks) and to use these factors to predict which infants have the highest risk of ECC.

STUDY DESIGN: Stepwise logistic regression and classification and regression tree (CART) analysis was performed to identify variables most associated with ECC and to build a parsimonious model to identify infants born preterm who are at the highest risk of ECC.

RESULTS: There were 12,622 infants eligible for analysis, (ECC, N=8465 vs deferred cord clamping (DCC), N=4157). In the CART model, center, lack of antenatal magnesium, cesarean delivery, lower gestational age, and antenatal hemorrhage, in that rank order, were the factors that contributed most to identifying which infants received ECC. Several additional factors were also statistically significant, including time to delivery after admission to the hospital as well as maternal race and ethnicity.

CONCLUSIONS: Our results suggest that there are multiple factors among extremely preterm pregnancies, including center, lack of antenatal magnesium, cesarean delivery, lower gestational age, and antenatal hemorrhage, that are associated with infants who are more likely to miss DCC. There are also differences in rates by maternal race and ethnicity in who receives DCC compared with ECC. Identifying these factors now can inform future research and encourage local and larger-scale quality improvement practice changes.