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Brown BE, Shah PS, Afifi JK, Sherlock RL, Adie MA, Monterrosa LA, Crane JM, Ye XY, El-Naggar WI; Canadian Neonatal Network and the Canadian Preterm Birth Network Investigators. Delayed Cord Clamping in Small for Gestational Age Preterm Infants. Am J Obstet Gynecol. 2021 Aug 9:S0002-9378(21)00867-X.

Background: Infants with restricted growth for age are frequently exposed to insufficient placental circulation and are more likely to develop postnatal complications. Delayed cord clamping at birth for these infants requires further exploration.

Objectives: To compare the short-term neonatal outcomes of delayed cord clamping vs. early cord clamping in small for gestational age preterm infants, and to explore if the effects of delayed cord clamping in small for gestational age preterm infants are different from those in non-small for gestational age preterm infants.

Study design: We conducted a national retrospective cohort study, including infants born at <33 weeks’ gestation and admitted to the Canadian Neonatal Network units between January 2015 and December 2017. Small for gestational age infants (birth weight <10th percentile for gestational age and sex) who received delayed cord clamping ≥30 seconds were compared with small for gestational age infants who received early cord clamping. Non-small for gestational age infants who received delayed cord clamping were also compared with those who received early cord clamping. The main study outcomes included a composite of mortality or major morbidity, neonatal morbidities, mortality, peak serum bilirubin, and number of blood transfusions. Multivariable logistic/linear regression models with generalized estimation equation approach were used to account for clustering of infants within centers.

Results: 9 722 infants met inclusion criteria, 1 027 (10.6%) were small for gestational age. The median (IQR) gestational age was 31 weeks (28,32). After adjustment for potential confounders, delayed cord clamping in small for gestational age infants was associated with reduction in composite outcome of mortality or major morbidity (aOR 0.60, 95% CI 0.42,0.86) compared to early cord clamping. There was no difference between the two groups in peak serum bilirubin. Many associated benefits of delayed cord clamping in small for gestational age infants were similar to those in non-small for gestational age infants.

Conclusion: Delayed cord clamping in small for gestational age preterm infants was associated with decreased odds of mortality or major morbidity. Many of the benefits of delayed cord clamping in the small for gestational age preterm infants were similar to those identified in the non-small for gestational age preterm infants.

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