Experience with physiological based cord clamping is associated with increased effect size: a post-hoc analysis of the ABC3 trial
Resuscitation, vol. 219, pp. 110921
Abstract
BACKGROUND: A preplanned exploratory analysis of the ABC3 trial, performed in all 10 NICU centres in the Netherlands, evaluating the effect of physiological-based cord clamping (PBCC) on intact survival in very preterm infants, found a positive association between intact survival and experience with the PBCC approach. OBJECTIVE: To evaluate the effect of PBCC on intact survival in preterm infants in centres with more experience with PBCC and in centres with less experience. METHODS: A post-hoc secondary analysis was performed. Experienced and less experienced centres participating in the ABC3 trial included 669 infants born before 30 weeks of gestation, who were randomized to stabilization with intact cord and clamping after reaching cardiorespiratory stability (PBCC) or clamping after 30-60 s followed by stabilization (time-based delayed cord clamping (TBCC)). Centres were defined as "experienced" when: (1) caregivers were trained in the PBCC approach with evaluation of video and RFM recording; (2) experience in previous studies; (3) early initiation of ABC3 and (4) ≥20 % of inclusions. The primary outcome was intact survival (survival without major cerebral injury and/or necrotizing enterocolitis (NEC)). Outcomes were adjusted for differences in baseline characteristics. RESULTS: Two centres were classified as "experienced" and the other eight as "less-experienced", and included 43.1 % and 56.9 % of infants respectively. In experienced centres, intact survival was higher after PBCC compared with TBCC (72 % vs. 59 %; aOR 1.93 (95 %CI 1.73-2.17, P < 0.001)), with lower mortality (10 % vs. 20 %; aOR 0.40 (95 % CI 0.25-0.63, P < 0.001)). In less experienced centres, intact survival was not different (72 % vs. 75 %; aOR 0.94 (95 % CI 0.64-1.39, P = 0.93)), with higher mortality (16 % vs. 9.1 %; aOR 1.92 (95 % CI 1.05-3.50, P = 0.03)). CONCLUSIONS: PBCC was associated with increased intact survival in centres that had more previous experience and exposure to PBCC, but not in centres with less experience. We recommend that the effect of experience and training for new approaches should be taken into consideration in future studies on PBCC.
Authors 26
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Ronny Knol Aachen
Leiden University Medical Center · Erasmus MC · Erasmus MC - Sophia Children’s Hospital
Affiliation as printed
Division of Neonatology, Department of Neonatal and Pediatric Intensive Care, Sophia Children's Hospital, Erasmus MC University Medical Center, Rotterdam, the Netherlands; Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands
Division of Neonatology, Department of Neonatal and Pediatric Intensive Care, Sophia Children's Hospital, Erasmus MC University Medical Center, Rotterdam, The Netherlands; Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
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Erasmus MC · Erasmus MC - Sophia Children’s Hospital
Affiliation as printed
Division of Neonatology, Department of Neonatal and Pediatric Intensive Care, Sophia Children's Hospital, Erasmus MC University Medical Center, Rotterdam, the Netherlands
Division of Neonatology, Department of Neonatal and Pediatric Intensive Care, Sophia Children's Hospital, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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Radboud University Nijmegen · Radboud University Medical Center · Amalia Kinderziekenhuis · Radboud Institute for Health Sciences
Affiliation as printed
Division of Neonatology, Department of Pediatrics, Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, the Netherlands
Division of Neonatology, Department of Pediatrics, Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, The Netherlands
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Emma Kinderziekenhuis · Amsterdam University Medical Centers · Amsterdam Reproduction Development · Vrije Universiteit Amsterdam · University of Amsterdam
Affiliation as printed
Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Amsterdam Reproduction & Development, Amsterdam, the Netherlands
Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Amsterdam Reproduction & Development, Amsterdam, the Netherlands
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Emma Kinderziekenhuis · Amsterdam University Medical Centers · Amsterdam Reproduction Development · Vrije Universiteit Amsterdam · University of Amsterdam
Affiliation as printed
Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Amsterdam Reproduction & Development, Amsterdam, the Netherlands
Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Amsterdam Reproduction & Development, Amsterdam, the Netherlands
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Affiliation as printed
Department of Neonatology, Isala Women and Children's Hospital, Zwolle, the Netherlands
Department of Neonatology, Isala Women and Children's Hospital, Zwolle, The Netherlands
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University Medical Center Groningen · Beatrix Kinderziekenhuis
Affiliation as printed
Division of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, the Netherlands
Division of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands
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Affiliation as printed
Department of Pediatrics, Maxima Medical Center, Veldhoven, the Netherlands
Department of Pediatrics, Maxima Medical Center, Veldhoven, The Netherlands
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Maastricht University Medical Centre · Maastricht University
Affiliation as printed
Department of Pediatrics, Maastricht University Medical Center, Maastricht, the Netherlands
Department of Pediatrics, Maastricht University Medical Center, Maastricht, The Netherlands
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University Medical Center Utrecht · Wilhelmina Children's Hospital
Affiliation as printed
Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
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Erasmus MC · Erasmus MC - Sophia Children’s Hospital
Affiliation as printed
Division of Neonatology, Department of Neonatal and Pediatric Intensive Care, Sophia Children's Hospital, Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Epidemiology and Biostatistics, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
Division of Neonatology, Department of Neonatal and Pediatric Intensive Care, Sophia Children's Hospital, Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Epidemiology and Biostatistics, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
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Thomas van den Akker Aachen
Leiden University Medical Center
Affiliation as printed
Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands; Athena Institute, VU University, Amsterdam, the Netherlands
Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands; Athena Institute, VU University, Amsterdam, The Netherlands
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Erasmus MC · Hudson Institute of Medical Research
Affiliation as printed
Division of Obstetrics and Fetal Medicine, Department of Obstetrics and Gynecology, Erasmus MC University Medical Center, Rotterdam, the Netherlands; The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
Division of Obstetrics and Fetal Medicine, Department of Obstetrics and Gynecology, Erasmus MC University Medical Center, Rotterdam, The Netherlands; The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
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Hudson Institute of Medical Research · Monash University
Affiliation as printed
The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia; Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
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Arjan B. te Pas corresponding Aachen Division of Neonatology Department of Pediatrics, Leiden University Medical Center
Leiden University Medical Center
Affiliation as printed
Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands. Electronic address: a.b.te_pas@lumc.nl
Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: a.b.te_pas@lumc.nl
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Emma Brouwer Aachen Division of Neonatology Department of Pediatrics, Leiden University Medical Center
Leiden University Medical Center
Affiliation as printed
Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
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Emma Kinderziekenhuis · Amsterdam University Medical Centers · Amsterdam Reproduction Development · Vrije Universiteit Amsterdam · University of Amsterdam
Affiliation as printed
Amsterdam Reproduction & Development, Amsterdam, the Netherlands
Department of Neonatology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Enrico Lopriore Aachen Division of Neonatology Department of Pediatrics, Leiden University Medical Center
Leiden University Medical Center
Affiliation as printed
Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
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Erasmus MC · Erasmus MC - Sophia Children’s Hospital
Affiliation as printed
Division of Neonatology, Department of Neonatal and Pediatric Intensive Care, Sophia Children’s Hospital, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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Affiliation as printed
Department of Neonatology, Isala Women and Children’s Hospital, Zwolle, The Netherlands
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University Medical Center Groningen · Beatrix Kinderziekenhuis
Affiliation as printed
Department of Pediatrics, Beatrix Children’s Hospital, University Medical Center Groningen, Groningen, The Netherlands
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Affiliation as printed
Department of Pediatrics, Maxima Medical Center, Veldhoven, The Netherlands
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Maastricht University Medical Centre · Maastricht University
Affiliation as printed
Department of Pediatrics, Maastricht University Medical Center, Maastricht, The Netherlands
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Emma Kinderziekenhuis · Amsterdam University Medical Centers · Vrije Universiteit Amsterdam · University of Amsterdam
Affiliation as printed
Department of Neonatology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Hudson Institute of Medical Research · Monash University
Affiliation as printed
Department of Paediatrics, Monash University, Clayton, Victoria, Australia
The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
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Sylke Jeanne Steggerda Aachen Division of Neonatology Department of Pediatrics, Leiden University Medical Center
Leiden University Medical Center
Affiliation as printed
Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
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