Association of delayed cord clamping with acute kidney injury and two-year kidney outcomes in extremely premature neonates: a secondary analysis of the preterm erythropoietin neuroprotection trial (PENUT).

BACKGROUND

Delayed cord clamping (DCC) occurs in most preterm births.

OBJECTIVE

Evaluate the association of DCC with acute kidney injury (AKI) and two-year kidney outcomes.

METHODS

Secondary analysis of the Preterm Erythropoietin Neuroprotection Trial of neonates born 24 to 27 weeks gestation. AKI and two year kidney outcomes were compared in neonates with DCC ( ≥ 30 s after delivery) to those with early cord clamping (ECC) (<30 s after delivery).

RESULTS

The incidence and severity of AKI did not differ between the DCC and ECC groups (aOR 1.17 [95%CI 0.76-1.80]). At two years corrected age, DCC was associated with a 4.5-fold increased adjusted odds of estimated glomerular filtration rate (eGFR) <90 mL/min/1.73m. No significant associations were noted between DCC and albuminuria or elevated blood pressure.

CONCLUSIONS

DCC was not associated with decreased neonatal AKI, but was associated with higher adjusted odds of eGFR <90 mL/min/1.73m at two years.