Delayed Cord Clamping and Early Neonatal Outcomes in Infants Born Before 30 Weeks of Gestation: A Retrospective Cohort Study

Objective: Delaying postpartum cord clamping may contribute to neonatal circulation by allowing continued placental transfusion. The timing of cord clamping is still debated and is called delayed cord clamping (DCC) if performed more than 30 s after birth. This study evaluated the effect of DCC on the clinical outcomes of preterm infants. Methods: Preterm infants (gestational age < 30 weeks) admitted to our Level 4 neonatal intensive care unit in 2023–2024 were evaluated retrospectively. Delayed cord clamping at postnatal 60 s was practiced when infants were considered stable. The demographic characteristics and morbidities of infants who did and did not have DCC were compared. Results: A total of 156 infants were included in the study. Of these, 70 infants were in the DCC group, and 86 infants were in the non-DCC group. Median gestational age was 28 weeks (interquartile range IQR: 26–30 weeks) and 26 weeks (IQR: 25–28 weeks), and median birth weight was 1000 g (IQR: 780–1300 g) and 850 g (IQR: 685–1095 g), respectively (p < 0.001 for both). The DCC group had a higher rate of antenatal steroid (ANS) use (p < 0.001), higher APGAR scores (p < 0.001), and lower rates of intraventricular hemorrhage (IVH) (p < 0.001), respiratory distress syndrome (RDS) (p < 0.001), bronchopulmonary dysplasia (BPD) (p = 0.013), feeding intolerance (p = 0.01), and mortality (p = 0.016) compared to the non-DCC group. Grade 3 IVH was not observed in the DCC group. In logistic regression analysis, not performing DCC was associated with significantly greater odds of IVH (odds ratio OR: 2.92, 95% CI: 1.48–5.77, p < 0.01), BPD (OR: 2.25, 95% CI: 1.18–4.29, p = 0.01), RDS (OR: 3.97, 95% CI: 1.86–8.48, p < 0.001), and mortality (OR: 3.44, 95% CI: 1.21–9.81, p < 0.01). However, these differences were not statistically significant after correcting for birth week, birth weight, Apgar score, and ANS. Conclusions: When applied in preterm infants under 30 weeks of gestational age, DCC can promote hemodynamic stability and reduce morbidities such as IVH and RDS. Also, implementing DCC with unstable infants will provide more conclusive information about its effectiveness.