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)

Abstract

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 24^0/7 to 27^6/7 weeks' gestation. AKI and two year kidney outcomes were compared in neonates with DCC (≥30 seconds after delivery) to those with early cord clamping (ECC) (<30 seconds 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 times increased adjusted odds of eGFR <90 mL/min/1.73m². No significant associations were noted between DCC and albuminuria or elevated BP.

Conclusions: DCC was not associated with decreased neonatal AKI, but was associated with higher adjusted odds of eGFR <90 mL/min/1.73m² at two years.

Keywords: acute renal failure; chronic kidney disease; delayed cord clamping; glomerular filtration rate; hypertension; long-term outcomes; prematurity.