Comparing two different placental transfusion strategies for very preterm infants at birth: a matched-pairs study

Abstract

Objective

To evaluate the clinical outcomes of using the extra-uterine placental transfusion (EPT) approach in very preterm infants (VPIs, gestational age <32 weeks) and compare this to delayed cord clamping (DCC) after birth.

Methods

In this matched pairs study, we compared the clinical outcomes of the EPT group to those of the DCC group. EPT were performed in fifty-three VPIs, of whom 27 were singletons and 25 were twins. The singleton VPIs were matched for gestational age (±5 days) and delivery mode, and the twin VPIs were matched between each other with the first twin subjected to DCC and the second twin to EPT. Data on the infants were collected and analysed as an overall group. A twin subgroup consisting of DCC and EPT groups was also analysed separately. The primary study outcome was either death or major morbidities.

Results

In total, 100 infants were included (n = 50 EPT group, n = 50 DCC group). The gestational ages of the DCC and EPT groups were (29.16 ± 1.76) and (29.12 ± 1.84) weeks, respectively. There were no differences in either deaths or major morbidities and other clinical outcomes, including the resuscitation variables, haemoglobin levels and red blood cell transfusion, between the two groups. In twin subgroups (gestational age 29.05 ± 1.89 weeks), EPT was associated with a higher rate of necrotizing enterocolitis (NEC) when compared with DCC (odds ratio = 7 (95% CI, 1.06 to 56.89), p = 0.031).

Conclusions

In twin subgroups, the incidence of NEC was higher in the EPT group when compared to the DCC group and therefore based on an abundance of caution the use of EPT in very preterm twins is not recommended.

KEY MESSAGE

1. Extra-uterine placental transfusion (EPT) is an alternative new form of placental transfusion. It can alleviate the problem of delayed respiratory support during DCC. It can also be performed in some placental abruption cases.

2. EPT may lead to the same clinical outcome as DCC in singleton pregnancies but based on an abundance of caution it is not recommended for very preterm twins.

Keywords:

• Very preterm infant
• delayed cord clamping
• extra-uterine placental transfusion
• singleton birth
• twin birth

Acknowledgements

The authors thank Professors Gerhard Jorch and Hui Ma for establishing the protocol for extra-uterine placental transfusion and guiding the writing of the manuscript. We also thank Dr Dev Sooranna of Imperial College London for editing the manuscript.

Authors contributions

Yan Wu performed the data analyses and wrote the manuscript;

Xiaoyun Zhong contributed to the conception of the study;

JiangfengOu helped perform the analysis with constructive discussions.

Gongxue Chen contributed to data collection

Yefang Zhu contributed significantly to analysis and manuscript preparation;

All authors agree to be accountable for all aspects of the work.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The datasets generated during the current study are available from the corresponding author on reasonable request.

Additional information

Funding

The work was supported by the Chongqing Science and Health Joint Medical Research Project (Nos. 2021MSXM239 & 2022ZDXM035) and the Chongqing Maternal and Child Scientific Research Project (No. 2021FY109).