Understanding how to give preterm babies the best possible start is a central focus in neonatal care. One practice that has gained worldwide interest is delayed/optimal umbilical cord clamping, which allows extra time for blood to transfer from the placenta to the newborn. While optimal clamping has been linked with improved cardiovascular stability, its effect on early brain oxygenation has been less clear.
A new secondary analysis from the COSGOD III trial provides important insight into this question.
What Was the Aim of the Study?
Researchers wanted to understand whether the timing of cord clamping affects how well the brain is oxygenated in the first 15 minutes after birth in babies born before 32 weeks gestation. Early cerebral oxygenation matters because it may influence immediate stability and possibly long-term outcomes.
The study focused on two measurements:
- cerebral regional oxygen saturation (crSO2), which reflects oxygen levels within brain tissues
- cerebral fractional tissue oxygen extraction (cFTOE), which reflects how much oxygen the brain is using
How Was the Study Conducted?
This analysis used data from the COSGOD III randomised clinical trial, conducted from 2017 to 2021 across 11 tertiary neonatal intensive care units in six countries in Europe and in Canada.
A total of 572 preterm infants under 32 weeks gestation were retrospectively assigned to three groups based on the timing of umbilical cord clamping:
- Group 1: less than 30 seconds (339 infants)
- Group 2: 30 to 60 seconds (164 infants)
- Group 3: more than 60 seconds (69 infants)
Researchers compared crSO2 and cFTOE during the first 15 minutes after birth.
What Did the Study Find?
No significant differences were found in crSO2 or cFTOE across the three groups. In other words, delaying cord clamping did not lead to higher brain oxygenation or different oxygen extraction during the first 15 minutes of life.
The study also examined key neonatal outcomes. There were no differences between groups in the rates of intraventricular haemorrhage, including severe grades, or cystic periventricular leukomalacia. Other major morbidities were also similar.
What Does This Mean for Clinical Practice?
The findings suggest that, within a modern neonatal care setting where oxygen is carefully titrated, the timing of cord clamping does not significantly influence early cerebral oxygenation in preterm infants.
Delayed cord clamping still has several known benefits, including improved blood volume and cardiovascular stability. This study simply indicates that immediate improvements in brain oxygenation may not be one of them.
Importantly, the study found no evidence of harm related to delayed clamping in terms of cerebral injury.
Why This Matters to SurePulse
These research findings are of particular interest to SurePulse, whose vision is a world where baby-centred innovation transforms neonatal outcomes. SurePulse is developing a wireless, multi-parameter monitoring device with the potential to be used straight after birth, even during delayed cord clamping, to give Clinicians quick and accurate vital signs information to guide treatment decisions. As research continues to highlight the complexity of the newborn transition, technologies that support Clinicians in real time are becoming increasingly important.
Conclusion
This secondary analysis of the COSGOD III trial indicates that the timing of umbilical cord clamping does not significantly affect brain oxygenation during the first 15 minutes after birth in preterm infants, when supplemental oxygen is managed according to protocol. Delayed cord clamping remains a valuable and safe practice, but its effect on early cerebral oxygenation appears limited under these clinical conditions.
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