The following is a summary of “Effect of Breathing Support in Very Preterm Infants Not Breathing During Deferred Cord Clamping: A Randomized Controlled Trial (The ABC Study),” published in the FEBRUARY 2023 issue of Pediatrics by Nevill, et al.

For a study, researchers sought to investigate whether providing respiratory support to very preterm infants who fail to breathe regularly during deferred cord clamping (DCC) reduced the need for red cell transfusion.

The study was conducted on infants under 31 weeks of gestation who were undergoing DCC, but were not breathing regularly or were apneic at 15 seconds. Pale, limp, and nonresponsive infants were excluded. These infants were randomly assigned to one of two groups: the standard group, which received gentle stimulation in a neutral position for 50 seconds, and the intervention group, which received intermittent positive pressure ventilation via face mask and T-piece from 20 to 50 seconds of age with fractional inspired oxygen of 0.3. The primary outcome measured was the proportion of infants transfused, with a secondary composite outcome of death, severe intraventricular hemorrhage, or chronic lung disease.

Out of 311 assessed infants, 113 met the inclusion criteria and were included in the study, with 57 receiving the intervention and 56 receiving standard treatment. The patient characteristics were similar in both groups. 105 infants (93%) received the intended 50 seconds of DCC, with 54 in the intervention group and 51 in the standard group. The rates of transfusion were similar in both groups (28% in the intervention group vs. 30% in the standard group), as were the composite outcome rates (46% in the intervention group vs. 38% in the standard group). The difference in the composite outcome between the two groups was not statistically significant (P = .45).

In the single-center cohort study, providing breathing support during 50 seconds of DCC seemed to be safe and feasible but did not decrease the transfusion rates or improve outcomes.

Reference: jpeds.com/article/S0022-3476(22)00847-2/fulltext