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Am J Perinatol 2020; 37(02): 210-215
DOI: 10.1055/s-0039-1697671
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Delayed Umbilical Cord Clamping is Not Associated with Acute Kidney Injury in Very Low Birth Weight Neonates

Matthew W. Harer 
1   Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
,
Ryan M. McAdams
1   Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
,
Mark Conaway
2   Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia
,
Brooke D. Vergales
3   Department of Pediatrics, University of Virginia, Charlottesville, Virginia
,
Dylan M. Hyatt
3   Department of Pediatrics, University of Virginia, Charlottesville, Virginia
,
Jennifer R. Charlton
3   Department of Pediatrics, University of Virginia, Charlottesville, Virginia
› Author Affiliations Funding This project was completed with no specific funding. J.R.C. is funded by Thelma R Swotzel Collaborative Research Award, R01DK110622 and R01DK111861.
Further Information

Publication History

09 May 2019

16 August 2019

Publication Date:
13 October 2019 (online)

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Abstract

Objective This study aimed to determine if delayed cord clamping (DCC) is associated with a reduction in neonatal acute kidney injury (AKI).

Study Design A retrospective single-center cohort study of 278 very low birth weight (VLBW) neonates was performed to compare the incidence of AKI in the following groups: immediate cord clamping (ICC), DCC, and umbilical cord milking. AKI was diagnosed by the modified neonatal Kidney Diseases and Improving Global Outcomes (KDIGO) definition.

Results The incidence of AKI in the first week was 20.1% with no difference between groups (p = 0.78). After adjustment for potential confounders, the odds of developing AKI, following DCC, compared with ICC was 0.93 (confidence interval [CI]: 0.46–1.86) with no reduction in the stage of AKI between groups.

Conclusion In this study, DCC was not associated with a reduced rate of AKI in VLBW neonates. However, the data suggest that DCC is also not harmful to the kidneys, further supporting the safety of DCC in VLBW neonates.

Keywords

acute kidney injury - delayed cord clamping - umbilical cord milking - very low birth weight - premature - preterm birth - neonate
 

  • References

  • 1 Katheria AC, Lakshminrusimha S, Rabe H, McAdams R, Mercer JS. Placental transfusion: a review. J Perinatol 2017; 37 (02) 105-111
    CrossrefPubMedGoogle Scholar
  • 2 Weiner GM, Zaichkin J. Textbook of Neonatal Resuscitation 7th ed. Elk Grove Village, IL: American Academy of Pediatrics and American Heart Association; 2016
    Google Scholar
  • 3 Wyllie J, Perlman JM, Kattwinkel J. , et al; Neonatal Resuscitation Chapter Collaborators. Part 7: neonatal resuscitation: 2015 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Resuscitation 2015; 95: e169-e201
    CrossrefPubMedGoogle Scholar
  • 4 Committee on Obstetric Practice. Committee opinion no. 684: delayed umbilical cord clamping after birth. Obstet Gynecol 2017; 129 (01) e5-e10
    CrossrefPubMedGoogle Scholar
  • 5 Fogarty M, Osborn DA, Askie L. , et al. Delayed vs early umbilical cord clamping for preterm infants: a systematic review and meta-analysis. Am J Obstet Gynecol 2018; 218 (01) 1-18
    CrossrefPubMedGoogle Scholar
  • 6 Backes CH, Rivera BK, Haque U. , et al. Placental transfusion strategies in very preterm neonates: a systematic review and meta-analysis. Obstet Gynecol 2014; 124 (01) 47-56
    CrossrefPubMedGoogle Scholar
  • 7 Nagano N, Saito M, Sugiura T, Miyahara F, Namba F, Ota E. Benefits of umbilical cord milking versus delayed cord clamping on neonatal outcomes in preterm infants: A systematic review and meta-analysis. PLoS One 2018; 13 (08) e0201528
    CrossrefPubMedGoogle Scholar
  • 8 Zappitelli M, Ambalavanan N, Askenazi DJ. , et al. Developing a neonatal acute kidney injury research definition: a report from the NIDDK neonatal AKI workshop. Pediatr Res 2017; 82 (04) 569-573
    CrossrefPubMedGoogle Scholar
  • 9 Jetton JG, Guillet R, Askenazi DJ. , et al; Neonatal Kidney Collaborative. Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates: Design of a Retrospective Cohort Study. Front Pediatr 2016; 4: 68
    PubMedGoogle Scholar
  • 10 Jetton JG, Boohaker LJ, Sethi SK. , et al; Neonatal Kidney Collaborative (NKC). Incidence and outcomes of neonatal acute kidney injury (AWAKEN): a multicentre, multinational, observational cohort study. Lancet Child Adolesc Health 2017; 1 (03) 184-194
    PubMedGoogle Scholar
  • 11 Charlton JR, Boohaker L, Askenazi D. , et al. Incidence and risk factors of early onset neonatal acute kidney injury. Clin J Am Soc Nephrol 2019; 14 (02) 184-195
    CrossrefPubMedGoogle Scholar
  • 12 Daga A, Dapaah-Siakwan F, Rajbhandari S, Arevalo C, Salvador A. Diagnosis and risk factors of acute kidney injury in very low birth weight infants. Pediatr Neonatol 2017; 58 (03) 258-263
    CrossrefPubMedGoogle Scholar
  • 13 Rabe H, Diaz-Rossello JL, Duley L, Dowswell T. Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes. Cochrane Database Syst Rev 2012; (08) CD003248
    PubMedGoogle Scholar
  • 14 Initiative KDOQ. KDIGO clinical practice guidelines for acute kidney injury. Kidney Int Suppl 2012; 2: 1-138
    CrossrefPubMedGoogle Scholar
  • 15 Sethi SK, Raghunathan V, Shah S. , et al. Fluid overload and renal angina index at admission are associated with worse outcomes in critically ill children. Front Pediatr 2018; 6: 118
    CrossrefPubMedGoogle Scholar
  • 16 Oh W, Oh MA, Lind J. Renal function and blood volume in newborn infant related to placental transfusion. Acta Paediatr 1966; 55 (02) 197-210
    PubMedGoogle Scholar
  • 17 Hosono S, Mugishima H, Fujita H. , et al. Blood pressure and urine output during the first 120 h of life in infants born at less than 29 weeks' gestation related to umbilical cord milking. Arch Dis Child Fetal Neonatal Ed 2009; 94 (05) F328-F331
    CrossrefPubMedGoogle Scholar
  • 18 Katheria AC, Truong G, Cousins L, Oshiro B, Finer NN. Umbilical cord milking versus delayed cord clamping in preterm infants. Pediatrics 2015; 136 (01) 61-69
    CrossrefPubMedGoogle Scholar
  • 19 Carmody JB, Harer MW, Denotti AR, Swanson JR, Charlton JR. Caffeine exposure and risk of acute kidney injury in a retrospective cohort of very low birth weight neonates. J Pediatr 2016; 172: 63-68.e1
    CrossrefPubMedGoogle Scholar
  • 20 Harer MW, Askenazi DJ, Boohaker LJ. , et al; Neonatal Kidney Collaborative (NKC). Association between early caffeine citrate administration and risk of acute kidney injury in preterm neonates: results from the AWAKEN study. JAMA Pediatr 2018; 172 (06) e180322
    CrossrefPubMedGoogle Scholar
  • 21 Gupta C, Massaro AN, Ray PE. A new approach to define acute kidney injury in term newborns with hypoxic ischemic encephalopathy. Pediatr Nephrol 2016; 31 (07) 1167-1178
    CrossrefPubMedGoogle Scholar