62 - Impact of Duration of Delayed Umbilical Cord Clamping (DCC) on Phototherapy Days in Newborn Premature Infants

Poster Number: 62
Publication Number: 62.192

Background: Delayed cord clamping (DCC) for up to 60 seconds in premature infants serves as an autologous blood transfusion and is associated with fewer blood transfusions, less need for vasopressor support, and reduced incidence of intraventricular hemorrhage. However, because DCC increases hematocrit, we hypothesized that longer durations of DCC would worsen hyperbilirubinemia. There are insufficient studies assessing how duration of DCC affects phototherapy (PTx) days in premature neonates.

Objective: To determine the effect of DCC duration on PTx days in premature newborns at different gestational ages (GA).

Design/Methods: We identified infants < 35 wks GA inborn between 1/1/2018-12/31/2022 (n=2846). We excluded infants with incomplete DCC data (n=254), congenital anomalies requiring immediate intervention (n=73), ABO and RH incompatibility (n=31), and cord milking (n=9). Infants were grouped into GA cohorts: < 27wks, 27-30wks, ≥31wks. We collected the following data: DCC duration, reason for reduced/no DCC, delivery mode, GA at birth, timing and duration of PTx, hemoglobin at birth (HgB), peak bilirubin (pBR), survival, and NICU length of stay. Within each GA stratum, we conducted Mann-Whitney tests to identify differences between infants who received DCC and those who did not. To identify predictors of PTx days, we conducted a multivariable linear regression (MiniTab) for each cohort, including the following variables: GA, HgB, pBR, duration of DCC, and delivery mode. p< 0.05 was considered significant.

Results: Demographic and clinical characteristics for each cohort are listed in Table 1. HgB, pBR, and PTx days were higher in preterm neonates ≥31wks who received DCC compared to those who did not (p=0.000), but were not significant in cohorts < 31wks. Additionally, pBR and PTx days differed based on duration of DCC only in the cohort of infants ≥31wks (Fig 1). In multivariable analysis, pBR was a significant predictor of PTx days in all 3 cohorts. GA was a significant predictor of PTx days in both cohorts of preterm infants ≥27wks. Vaginal delivery and HgB were significant predictors only in preterm neonates ≥31wks. In this model, when accounting for those additional clinical factors, duration of DCC was not a significant predictor of PTx days in any GA cohort (Table 2).

Conclusion(s): Providing increased blood volume via longer durations of DCC is not associated with increased PTx days in premature neonates < 35 weeks GA. Given that inadvertently causing significant hyperbilirubinemia did not occur, our study suggests that DCC up to 60 seconds remains a safe practice in premature neonates.
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