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

Figures & data

Figure 1. An image of the EPT procedure with the intact cord and the placenta attached.

Figure 2. A flow diagram showing the patient recruitment protocol used in this study.

Table 1. The maternal demographics of the subjects in this study.

	Overall			Twins
	DCC (n = 50)	EPT (n = 50)	P value	Twins (n = 25)
Caesarean section, n (%)	50(100%)	50 (100%)	–	25 (100%)
Antenatal steroids (full dose), n (%)	38 (76%)	41 (82%)	0.375	19 (76%)
Maternal magnesium, n (%)	39 (78%)	38 (76%)	1.000	20 (80%)
Hypertensive disorders of pregnancy, n (%)	6 (12%)	7 (14%)	1.000	1 (4%)
Maternal diabetes, n (%)	14 (28%)	13 (26%)	1.000	8 (32%)
Chorioamnionitis, n (%)	8 (16%)	8 (16%)	1.000	5 (20%)
Postpartum haemorrhage, mL (n = 25)	537.96 ± 192.28	453.32 ± 104.13	0.065	508.04 ± 109.60

Table 2. The neonatal demographics and delivery room outcomes of the infants in this study.

	Overall			Twins			Singletons
	DCC N = 50	EPT N = 50	P value	DCC N = 25	EPT N = 25	P value	DCC N = 25	EPT N = 25	P value
Gestation, weeks	29.16 ± 1.76	29.12 ± 1.84	0.241	29.05 ± 1.89	29.05 ± 1.89	--	29.27 ± 1.64	29.19 ± 1.82	0.245
Birth weight, grams	1258.40 ± 321.42	1214.20 ± 291.11	0.174	1189.60 ± 300.91	1199.60 ± 263.11	0.765	1327.20 ± 332.45	1228.80 ± 321.47	0.078
IUGR n (%)	4(8%)	3(6%)	1.000	3(12%)	2(8%)	1.000	1(5%)	1(5%)	1.000
Male, n (%)	28 (56%)	26 (52%)	0.815	14 (56%)	15 (60%)	1.000	14(56%)	11(44%)	0.549
Time of cord clamping, s	63.00 ± 16.35	244.36 ± 137.04	0.000	63.20 ± 17.25	209.88 ± 109.84	0.000	62.80 ± 15.68	287.32 ± 150.51	0.000
Apgar score
1min	8.50 (7.75, 9.25)	8.5 (7.0,9.0)	0.884	9 (8,9.5)	8 (7,9)	0.350	8(7,9.5)	9(7,9.5)	0.635
5min	9.00 (9.00,10.00)	9.0 (8.0,10.0)	0.706	10 (9,10)	9 (8.5,10)	0.600	9(8,10)	9(8,10)	1.000
10min	10.00 (9.00,10.00)	10.0 (9.0,10.0))	0.644	10 (9,10)	10 (9,10)	0.751	10 (9,10)	10 (9,10)	0.750
PPV with mask in DR, n (%)	8 (16%)	10 (20%)	0.754	4(16%)	4(16%)	1.000	4(16%)	6(24%)	0.687
Intubation in DR, n (%)	5 (10%)	7 (14%)	0.754	2 (8%)	2 (8%)	1.000	3(12%)	5(20%)	0.727
Mechanical Ventilation in the first 72 h, n (%)	5 (10%)	6 (12%)	1.000	3 (12%)	2 (8%)	1.000	2(8%)	4(16%)	0.687
HCT (umbilical cord blood) %	39.70 ± 8.29	43.76 ± 7.34	0.067^a	38.62 ± 8.21	41.44 ± 6.17	0.337^b	40.71 ± 8.53	45.23 ± 8.59	0.221^c
Haemoglobin (umbilical cord blood) g/L	134.81 ± 26.15	145.23 ± 23.87	0.106^a	128.62 ± 25.01	136.38 ± 20.08	0.378^b	140.69 ± 26.70	151.23 ± 27.41	0.324^c
Admission HCT %	50.45 ± 6.21	50.61 ± 7.57	0.884	49.08 ± 5.33	48.63 ± 8.53	0.790	51.82 ± 6.81	52.60 ± 6.05	0.596
Admission Haemoglobin g/L	164.82 ± 20.75	166.68 ± 20.07	0.574	160.00 ± 17.28	161.88 ± 19.57	0.678	169.64 ± 23.07	171.48 ± 19.78	0.712
HCT in 12–24 h %	53.89 ± 7.31	55.34 ± 6.88	0.296	52.97 ± 7.68	54.88 ± 6.91	0.292	54.82 ± 6.95	55.80 ± 6.96	0.647
HB in 12–24 h g/L	186.58 ± 28.41	191.52 ± 25.86	0.348	183.48 ± 28.24	190.36 ± 26.84	0.321	189.68 ± 28.82	192.68 ± 25.34	0.712
Admission Temperature (°C)	36.82 ± 0.38	36.75 ± 0.33	0.239	36.83 ± 0.46	36.80 ± 0.33	0.723	36.81 ± 0.30	36.69 ± 0.33	0.224
Urine output over the first 24 h (mL/kg/h)	3.39 ± 1.20	3.61 ± 1.45	0.324	3.21 ± 0.91	3.48 ± 1.17	0.282	3.57 ± 1.43	3.79 ± 1.70	0.577

^a Based on n = 26 matched pairs in which umbilical cord blood was successfully collected in both infants.

^b,c Based on n = 13 matched pairs in which umbilical cord blood was successfully collected in both infants.

Table 3. The neonatal outcomes of the infants in this study.

	Overall				Twins				Singletons
	DCC n = 50	EPT n = 50	P value	OR	DCC n = 25	EPT n = 25	P value	OR	DCC n = 25	EPT n = 25	P value	OR
Necrotizing enterocolitis (II stage)	4(8%)	9 (18%)	0.227	2.67 (0.71 ∼ 10.05)	1 (4%)	7 (28%)	0.031	7.00 (1.06 ∼ 56.89)	3 (12%)	2 (8%)	1.000	0.67(0.11-4.00)
Death	3 (6%)	9 (18%)	0.109	4.00(0.85 ∼ 18.84)	1 (4%)	6 (24%)	0.063	6.00 (0.72 ∼ 49.84)	2 (4%)	3 (12%)	1.000	1.50(0.25-8.98)
Polycythaemia	2 (4%)	4 (8%)	0.687	2.00(0.37 ∼ 10.92)	1 (4%)	2 (8%)	1.000	2.00 (0.18 ∼ 22.06)	1 (4%)	2 (8%)	1.000	2.00 (0.18-22.06)
Required blood transfusion in 7 days	3 (6%)	4 (8%)	1.000	1.50 (0.25 ∼ 8.98)	3 (12%)	2 (8%)	1.000	0.50 (0.05 ∼ 5.51)	0	2 (8%)	0.500	---
Required blood transfusion in 28 days	7 (14%)	10 (20%)	0.581	1.60 (0.52 ∼ 4.89)	5 (20%)	7 (28%)	0.727	1.67 (0.40 ∼ 6.97)	2 (8%)	3(12%)	1.000	1.50(0.25-8.98)
Retinopathy necessitating surgery	3 (6%)	1 (2%)	0.625	0.33 (0.03 ∼ 3.20)	3 (12%)	1 (4%)	0.625	0.33 (0.03 ∼ 3.20)	0	0	---	---
Patent ductus arteriosus	22 (44 %)	29 (58%)	0.210	1.87 (0.79 ∼ 4.42)	12 (48%)	17 (68%)	0.227	2.67 (0.71,10.05)	10 (40%)	12 (48%)	0.774	1.40 (0.44,4.41)
Treated PDA (Ibuprofen), n (%)	7(14%)	13(26%)	0.180	2.50(0.78, 7.97)	3(12%)	5(20%)	0.500	---	4(16%)	8(32%)	0.388	2.00(0.60-6.64)
Intraventricular hemorrhage	9 (18%)	8 (16%)	1.000	0.80 (0.21 ∼ 2.98)	5 (25%)	3 (12%)	0.625	0.33 (0.03 ∼ 3.20)	4 (16%)	5 (20%)	1.000	1.50 (0.25-8.98)
Severe IVH	0	1 (2%)	1.000	--	0	1 (4%)	1.000	——	0	0	---	---
Pulmonary haemorrhage	0	3 (6%)	1.000	--	0	2 (8%)	0.500	——	0	1 (4%)	1.000	---
Spontaneous intestinal perforation	1 (2%)	1 (2%)	1.000	1.00 (0.06 ∼ 15.99)	1(4%)	0	1.000	——	0	1 (4%)	1.000	---
Bronchopulmonary dysplasia	3 (6%)	5 (10%)	0.687^a	2.00 (0.37, 10.92)	1 (4%)	3 (12%)	0.500^b	3.00 (0.31 ∼ 28.84)	2 (8%)	2 (8%)	1.000	1.00 (0.14-7.10)
EOS	6 (12%)	10 (20%)	0.454	1.67 (0.61 ∼ 4.59)	5(20%)	4 (16%)	1.000	0.80 (0.21 ∼ 2.98)	1 (4%)	6 (24%)	0.125	6.00 (0.722,49.84)
LOS	8 (16%)	10 (20%)	0.804	1.29 (0.48 ∼ 3.45)	5(20%)	5 (20%)	1.000	1.00 (0.25 ∼ 3.99)	3 (12%)	5 (20%)	0.727	1.67 (0.40,6.97)
Hospital length of stay, days	38.00 (24.00, 56.50)	43.00 (29.50, 62.5)	0.619	--	35.00(25.00,50.50)	43.00(29.50, 62.50)	0.571	--	38.00 (24.00,56.50)	43.00 (29.50,62.50)	0.619	--

^a Based on n = 39 matched pairs in which both infants’ survival at 36 weeks post-menstrual age or discharge.

^b Based on n = 19 matched pairs in which both infants’ survival at 36 weeks post-menstrual age or discharge.

Figure 3. (A) Heart rate. All the presented data were based on all matched pairs n = 50. (B) Oxygen saturation. data of infants who were subjected to either DCC or EPT were calculated based on n = 12 at t = 1min, n = 34 at t = 2 min, n = 49 at t = 3 min, respectively. All the other presented data were based on n = 50. (C) Heart rate. The presented data were based on all the twins recruited, n = 25. (D) Oxygen saturation. The data on infants who were subjected to either DCC or EPT were calculated based on n = 2 at t = 1min, n = 11 at t = 2 min and n = 24 at t = 3 min, respectively. All the other presented data were based on n = 25.

Table 4. The heart rate during transition of the infants.

Time after birth	Heart rate, bpm
	Overall				Twins
	DCC (n = 50)	EPT (n = 50)	Z	P value	DCC (n = 25)	EPT (n = 25)	Z	P value
1min	112 (100, 125)	120 (108, 131)	−0.86	0.39	120 (110, 130)	110 (99, 123.5)	−1.07	0.29
2 min	122 (100, 135)	130 (101, 144)	−0.51	0.61	131 (120, 146)	120 (100, 136)	−2.22	0.03
3 min	140 (112, 151)	138 (104, 145)	−1.22	0.22	147(133, 152)	132 (103, 147)	−2.37	0.02
5 min	147 (131, 156)	146 (130, 150)	−0.65	0.52	149 (141, 160)	145 (131, 154)	−1.83	0.06
7 min	148 (132, 159)	150 (140, 155)	−0.48	0.63	153 (142, 161)	150 (138, 156)	−0.09	0.93
10 min	150 (134, 159)	155 (144, 165)	−1.66	0.09	151 (147, 161)	150 (142, 165)	−0.37	0.72

Table 5. Oxygen saturation during transition of the infants.

Time after birth	Oxygen saturation (%)
	Overall				Twins
	DCC	EPT	Z	P value	DCC	EPT	Z	P value
1min	60 (49, 68)	52 (41, 66)	−1.10	0.27 ^a	59 (52, 64)	52 (44, 71)	–	–
2 min	56 (47, 66)	55 (46,64)	−0.66	0.51 ^b	56 (51, 64)	57.5 (50, 61)	−1.16	0.25 ^c
3 min	62 (57, 73)	62 (55, 72)	−0.08	0.94^d	61 (52, 70)	69 (58, 75)	−1.37	0.17^e
5 min	74 (63, 85)	72 (60, 83)	−0.25	0.80	72 (64, 82)	80 (66, 86)	−0.97	0.33
7 min	82 (72, 90)	85 (80,90)	−0.85	0.40	82 (72, 90)	90 (80, 92)	−1.04	0.30
10 min	92 (84, 94)	92 (88,94)	−1.40	0.16	92 (84, 94)	93 (89, 95)	−1.16	0.25

^a Based on n = 12 matched pairs in which the oxygen saturation was measured in both infants at 1 min after delivery.

^b Based on n = 34 matched pairs in which the oxygen saturation was measured in both infants at 2 min after delivery.

^c Based on n = 11 matched pairs in which the oxygen saturation was measured in both twins at 2 min after delivery.

^d Based on n = 49 matched pairs in which the oxygen saturation was measured in both infants at 3 min after delivery.

^e Based on n = 24 matched pairs in which the oxygen saturation was measured in both twins at 3 min after delivery.

Data availability statement

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