Does Timing of Cord Clamping Influence Brain Oxygenation in Preterm Infants? A Secondary Analysis from COSGOD III
- georgschmoelzer
- 52 minutes ago
- 2 min read
Over the past decade, deferred umbilical cord clamping has gained traction in neonatal care, with the potential to improve cardiovascular transition and reduce neonatal morbidities in preterm infants. But can delaying cord clamping influence cerebral oxygenation in the critical minutes following birth?
A newly published secondary analysis of the COSGOD III trial investigated whether different timings of cord clamping affect cerebral regional tissue oxygen saturation (crSO₂) and cerebral fractional tissue oxygen extraction (cFTOE) during the first 15 minutes after birth in preterm neonates.
Study Design
This was a post-hoc secondary outcome analysis of the COSGOD III randomized controlled trial, conducted from 2017 to 2021 across 11 tertiary NICUs in six countries (Europe and Canada). The study included 572 preterm infants <32 weeks’ gestation, retrospectively grouped by cord clamping timing:
G1: Early clamping <30 seconds (n=339)
G2: Intermediate clamping 30–60 seconds (n=164)
G3: Deferred clamping >60 seconds (n=69)
The researchers evaluated crSO₂ and cFTOE during the first 15 minutes of life using near-infrared spectroscopy, alongside secondary outcomes including neonatal brain injury (IVH and PVL).
Key Findings
No significant differences in crSO₂ or cFTOE were observed between the three groups.
There was no measurable association between cord clamping time and the incidence of cerebral injury (IVH or cystic PVL).
The absence of differences may be partly attributed to protocol-driven titration of supplemental oxygen, which could have normalized cerebral oxygenation across all groups.
What Does This Mean?
While previous research has linked deferred cord clamping with cardiovascular and hematologic benefits, this analysis suggests that its effect on early cerebral oxygenation may be limited, particularly in settings where oxygen delivery is closely titrated.
The findings reinforce that optimizing oxygen support—rather than focusing solely on the timing of cord clamping—may play a more direct role in maintaining cerebral oxygenation during neonatal transition.
Conclusion
This secondary analysis from COSGOD III did not demonstrate a significant effect of cord clamping timing on brain oxygenation in the first 15 minutes after birth in preterm infants. Further studies are needed to explore how delivery room interventions interact to influence neurodevelopmental outcomes.
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