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)

Henry A Zapata; Namrata Todurkar; Kristen Favel; Russell L Griffin; Michelle C Starr; Jennifer R Charlton; Ryan M McAdams; David Askenazi; Tapas Kulkarni; Shina Menon; Cherry Mammen; Matthew W Harer

doi:10.1038/s41372-024-02143-7

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)

J Perinatol. 2025 Jan;45(1):85-93. doi: 10.1038/s41372-024-02143-7. Epub 2024 Oct 11.

Authors

Affiliations

¹ University of Florida College of Medicine Jacksonville, Division of Neonatology, Jacksonville, FL, USA.
² University of British Columbia, Department of Pediatrics, Vancouver, BC, Canada.
³ University of California San Francisco, Division of Pediatric Nephrology, San Francisco, CA, USA.
⁴ University of Alabama Birmingham, Department of Epidemiology, Birmingham, AL, USA.
⁵ Indiana University School of Medicine, Division of Pediatric Nephrology, Indianapolis, IN, USA.
⁶ University of Virginia, Department of Pediatrics, Charlottesville, VA, USA.
⁷ University of Wisconsin, Division of Neonatology, Madison, WI, USA.
⁸ University of Alabama Birmingham, Department of Pediatrics, Birmingham, AL, USA.
⁹ Stanford University, Department of Pediatrics, Division of Pediatric Nephrology, Palo Alto, CA, USA.
¹⁰ University of Wisconsin, Division of Neonatology, Madison, WI, USA. [email protected].

^# Contributed equally.

PMID: 39390245
DOI: 10.1038/s41372-024-02143-7

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 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/1.73m². 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/1.73m² at two years.

Publication types

Randomized Controlled Trial

MeSH terms

Acute Kidney Injury* / etiology
Acute Kidney Injury* / prevention & control
Erythropoietin* / therapeutic use
Female
Gestational Age
Glomerular Filtration Rate*
Humans
Incidence
Infant, Extremely Premature*
Infant, Newborn
Male
Pregnancy
Time Factors
Umbilical Cord
Umbilical Cord Clamping*

Substances

Erythropoietin