Preterm Birth
Conditions
Brief summary
To establish if placental transfusion, using deferred cord clamping for 60 seconds or more while holding the baby at or below the level of the placenta, will improve survival without disability compared with standard early cord clamping in preterm babies less than 30 weeks of gestation.
Detailed description
Most preterm babies have the umbilical cord clamped within 10 seconds of birth. Placental transfusion is a simple way of giving the baby extra blood at birth by delaying the clamping of the umbilical cord by 60 seconds or more. There is promising evidence from randomised trials that placental transfusion in babies less than 37 weeks of pregnancy may improve their blood pressure, reduce the number of blood transfusions needed and decrease bleeding into the brain, bowel disease and infection. However, we not know if babies born before 30 weeks of pregnancy benefit or if placental transfusion increases or decreases death or childhood disability. Despite this uncertainty more doctors are recommending that all very preterm babies are given a placental transfusion at birth. It is important to find out if placental transfusion does more good than harm, before it becomes even more widely used. The Australian Placental Transfusion Study will enrol at least 1600 women who will give birth to babies born less than 30 weeks of gestation. These participants will be randomly assigned to either standard treatment where the umbilical cord is clamped within 10 seconds of birth or a second method where the umbilical cord will be clamped after waiting for 60 seconds or more at birth while the baby is being held below the level of the placenta. The main research question is whether placental transfusion reduces death and disability when the baby is discharged from hospital and into childhood.
Interventions
PROCEDUREDeferred cord clamping
Deferred cord clamping (for 60 seconds or more with the baby held below or at the level of the placenta)
Sponsors
National Health and Medical Research Council, Australia
Baylor College of Medicine
University of Sydney
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
FEMALE
Healthy volunteers
No
Inclusion criteria
Women who have a reasonable chance of delivering less than 30 weeks of gestation. Informed consent has been received from the parent or guardian.
Exclusion criteria
No indication or contraindication to placental transfusion, in the view of mother or baby.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Death and/or major morbidity at 36 weeks post menstrual age | 36 weeks post menstrual age | Composite death and/or major morbidity at 36 completed weeks post menstrual age. Morbidity is defined by one or more of the following: brain injury on ultrasound, severe retinopathy, necrotising enterocolitis, late onset sepsis. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Patent ductus arteriosis requiring treatment (documented in medical records) | 36 completed weeks post menstrual age | — |
| Incidence of death | 36 completed weeks post menstrual age | The death component of the composite primary outcome |
| Incidence of major morbidity | 36 completed weeks post menstrual age | Major morbidity (incidence of one or more of brain injury on ultrasound, severe retinopathy, necrotising enterocolitis or late onset sepsis). |
| Incidence of death or major disability | Up to 3 years corrected age | Death or major disability (for example cerebral palsy with inability to walk; blindness; deafness; major problems with language or speech; ASQ score indicative of developmental delay) |
| Incidence of death or brain injury on ultrasound | 36 completed weeks post menstrual age | Death or brain injury on ultrasound |
| Major disability defined as cerebral palsy with an inability to walk unassisted, severe visual loss, deafness, major problems with language or speech, or a score indicative of developmental delay on Ages and Stages Questionnaire. | Up to 3 years corrected age | — |
| Brain injury on ultrasound | 36 completed weeks post menstrual age | — |
| Necrotizing enterocolitis with the following signs: at least 1 systemic sign, profile consistent with definite NEC, warranted treatment for NEC. | 36 completed weeks post menstrual age | — |
| IVH (Grades 3 & 4) seen on ultrasound | 36 completed weeks post menstrual age | — |
| IVH (Grade 4) seen on ultrasound | 36 completed weeks post menstrual age | — |
| Severe retinopathy warranting treatment or Stage 4 retinopathy according to the Australian and New Zealand Neonatal Network (ANZNN) definitions | 36 completed weeks post menstrual age | — |
| Chronic lung disease, defined as receiving supplemental oxygen or any form of assisted ventilation at 36 completed weeks post menstrual age for 4 consecutive hours in a 24 hour period | 36 completed weeks post menstrual age | — |
| Late onset sepsis, defined as a clinical picture consistent with sepsis, and either a positive culture of blood and/or CSF, or a positive urine culture by sterile collection, and at least 5 days of antibiotic treatment. | 36 completed weeks post menstrual age | — |
| Death up to 3 years corrected age | Up to 3 years corrected age | — |
| IVH (all grades) seen on ultrasound | 36 completed weeks post menstrual age | — |
Countries
Australia, Canada, France, New Zealand, Pakistan, United Kingdom, United States
Outcome results
None listed