Premature Infants Receiving Milking or Delayed Cord Clamping: PREMOD2

NCT ID: NCT03019367

Last Updated: 2022-11-23

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

1201 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-06-06

Study Completion Date

2022-09-16

Brief Summary

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This study is being done to find out whether umbilical cord milking (UCM) is at least as good as or better than delayed cord clamping (DCC) to reduce bleeding in the brain or prevent death in premature newborns. The investigators will study short and long term outcomes of infants delivered before 32 weeks gestation that receive either UCM or DCC.

\* The trial was stopped by the DSMB for safety in the small strata. They subsequently allowed for continuation of the trial in infants 29-32+6 wk GA.

Detailed Description

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Aim 1. Compare the incidence of severe intraventricular hemorrhage (IVH) and/or death in premature newborns \<33 weeks gestational age (GA) delivered by C/S receiving UCM to those receiving DCC.

Hypothesis1: First demonstrate infants in the UCM group are not inferior to the DCC group (reject H10).

Hypothesis2: If H1 is true, demonstrate lower incidence of severe IVH and/or death in UCM infants compared to DCC.

Aim 2. Compare the safety and efficacy profiles of premature newborns \<33 weeks GA delivered by C/S receiving UCM vs. DCC during their hospitalization.

Hypothesis3: UCM group will have a decreased need for resuscitation interventions with no differences in bilirubin or polycythemia compared to DCC.

Hypothesis4: UCM group will have improved blood pressures in the first 24 hours of life compared to DCC.

Aim 3 (exploratory). To compare the outcomes of premature newborns \<33 weeks GA delivered by C/S (Cesarean section) (from Aims 1 and 2) with those born by V/D (vaginal delivery) receiving UCM or DCC.

Conditions

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Intraventricular Haemorrhage Neonatal Death; Neonatal

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

TRIPLE

Caregivers Investigators Outcome Assessors
It is not possible to blind the delivering obstetrician, however all other caregivers will be blinded. The procedure will be documented as "placental transfusion" in the delivery summary or admission-progress notes and all study assessments whether primary (head US) or secondary (neurodevelopmental exams) will be performed by blinded team members.

Study Groups

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Umbilical cord milking UCM

Milking the umbilical cord 4 times towards the infant at a speed of 20cm/2seconds.

Group Type ACTIVE_COMPARATOR

Umbilical cord milking UCM

Intervention Type PROCEDURE

At delivery, the umbilical cord is grasped, and blood is pushed toward the infant 4 times before it is clamped. This procedure infuses a placental transfusion of blood into the preterm neonate and can be done in 15-20 seconds.

Delayed cord clamping DCC

Delayed clamping of the umbilical cord for at least 60 seconds.

Group Type ACTIVE_COMPARATOR

Delayed cord clamping DCC

Intervention Type PROCEDURE

At delivery, delayed cord clamping will be performed by having the delivering obstetrician delay clamping of the umbilical cord for at least 60 seconds.

Interventions

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Umbilical cord milking UCM

At delivery, the umbilical cord is grasped, and blood is pushed toward the infant 4 times before it is clamped. This procedure infuses a placental transfusion of blood into the preterm neonate and can be done in 15-20 seconds.

Intervention Type PROCEDURE

Delayed cord clamping DCC

At delivery, delayed cord clamping will be performed by having the delivering obstetrician delay clamping of the umbilical cord for at least 60 seconds.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* 23 to 32 +6 Gestational age (currently enrolling 29 to 32+6 weeks)
* Multiples without Twin-to-twin Transfusion Syndrome (TTTS)

Exclusion Criteria

* Congenital anomalies
* Major cardiac defects
* Placental abruption or previa with hemorrhage
* Cord prolapse
* Hydrops
* Bleeding Accreta
* Monochorionic multiples with evidence of TTTS
* Fetal or maternal risk (i.e. compromise)
* Parents declined study
* Unlikely to return for 2 yr Follow Up
Minimum Eligible Age

23 Weeks

Maximum Eligible Age

33 Weeks

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Sharp Mary Birch Hospital for Women & Newborns

OTHER

Sponsor Role collaborator

Loma Linda University

OTHER

Sponsor Role collaborator

University of Pittsburgh

OTHER

Sponsor Role collaborator

Providence Hospital

OTHER

Sponsor Role collaborator

University of Alabama at Birmingham

OTHER

Sponsor Role collaborator

University of Alberta

OTHER

Sponsor Role collaborator

University College Cork

OTHER

Sponsor Role collaborator

University of Ulm

OTHER

Sponsor Role collaborator

Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)

NIH

Sponsor Role collaborator

Christiana Care Health Services

OTHER

Sponsor Role collaborator

Sharp Grossmont Hospital

OTHER

Sponsor Role collaborator

University of Utah

OTHER

Sponsor Role collaborator

University of Mississippi Medical Center

OTHER

Sponsor Role collaborator

PIH Health Good Samaritan Hospital

UNKNOWN

Sponsor Role collaborator

University of California, Irvine

OTHER

Sponsor Role collaborator

Children's Hospital Medical Center, Cincinnati

OTHER

Sponsor Role collaborator

Cook County Health

OTHER_GOV

Sponsor Role collaborator

St. Louis University

OTHER

Sponsor Role collaborator

LAC+USC Medical Center

OTHER

Sponsor Role collaborator

Sharp HealthCare

OTHER

Sponsor Role lead

Responsible Party

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Anup Katheria, M.D.

Director of Neonatal Research Institute

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Anup C Katheria, MD

Role: PRINCIPAL_INVESTIGATOR

Sharp HealthCare

Locations

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University of Alabama

Birmingham, Alabama, United States

Site Status

Loma Linda Medical Center

Loma Linda, California, United States

Site Status

LAC+USC Medical Center

Los Angeles, California, United States

Site Status

PIH Health Good Samaritan Hospital

Los Angeles, California, United States

Site Status

University of California, Irvine Medical Center

Orange, California, United States

Site Status

Sharp Grossmont Hospital

San Diego, California, United States

Site Status

Sharp Mary Birch Hospital for Women and Newborns

San Diego, California, United States

Site Status

Christiana Care

Newark, Delaware, United States

Site Status

John H. Stroger, Jr. Hospital of Cook County

Chicago, Illinois, United States

Site Status

University of Mississippi Medical Center

Jackson, Mississippi, United States

Site Status

St. Louis University

St Louis, Missouri, United States

Site Status

Cincinnati Children's Hospital

Cincinnati, Ohio, United States

Site Status

Providence St. Vincent Medical Center

Portland, Oregon, United States

Site Status

Magee-Womens Hospital

Pittsburgh, Pennsylvania, United States

Site Status

University of Utah

Salt Lake City, Utah, United States

Site Status

Governors of University of Alberta

Edmonton, Alberta, Canada

Site Status

University of ULM

Ulm, Baden-Wurttemberg, Germany

Site Status

Cork University Maternity Hospital

Cork, , Ireland

Site Status

Countries

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United States Canada Germany Ireland

References

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Katheria AC, Allman P, Szychowski JM, Essers J, Carlo WA, Schmolzer GM, Dempsey E, Yanowitz T, Kaempf J, Vora F, Bhat S, Arnell K, Rich W, Varner M. Perinatal Outcomes of Subjects Enrolled in a Multicenter Trial with a Waiver of Antenatal Consent. Am J Perinatol. 2022 Jun;39(8):904-908. doi: 10.1055/s-0040-1719184. Epub 2020 Nov 3.

Reference Type DERIVED
PMID: 33142340 (View on PubMed)

Katheria A, Reister F, Essers J, Mendler M, Hummler H, Subramaniam A, Carlo W, Tita A, Truong G, Davis-Nelson S, Schmolzer G, Chari R, Kaempf J, Tomlinson M, Yanowitz T, Beck S, Simhan H, Dempsey E, O'Donoghue K, Bhat S, Hoffman M, Faksh A, Arnell K, Rich W, Finer N, Vaucher Y, Khanna P, Meyers M, Varner M, Allman P, Szychowski J, Cutter G. Association of Umbilical Cord Milking vs Delayed Umbilical Cord Clamping With Death or Severe Intraventricular Hemorrhage Among Preterm Infants. JAMA. 2019 Nov 19;322(19):1877-1886. doi: 10.1001/jama.2019.16004.

Reference Type DERIVED
PMID: 31742630 (View on PubMed)

Related Links

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Other Identifiers

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1R01HD088646-01A1

Identifier Type: NIH

Identifier Source: secondary_id

View Link

PREMOD2

Identifier Type: -

Identifier Source: org_study_id

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