Cord Clamping Among Neonates With Congenital Heart Disease

NCT ID: NCT06153459

Last Updated: 2025-08-05

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

RECRUITING

Clinical Phase

NA

Total Enrollment

500 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-12-19

Study Completion Date

2030-12-31

Brief Summary

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The goal of this clinical trial is to compare 2 different timepoints for clamping the umbilical cord at birth for term-born infants with a prenatal diagnosis of congenital heart disease (CHD). The main questions it aims to answer are:

* Does Delayed Cord Clamping at 120 seconds (DCC-120) or Delayed Cord Clamping at 30 seconds (DCC-30) after birth lead to better health outcomes?
* Does DCC-120 seconds or DCC-30 seconds after birth lead to better neuromotor outcomes at 22-26 months of infant age (postnatal)?

Participants will be asked to do the following:

* Participate in either DCC-120 or DCC-30 at birth (randomized assignment).
* Complete General Movements Assessment (GMA) at 3-4 months of infant age (postnatal), complete questionnaires / surveys at this time.
* Complete questionnaires / surveys at 9-12 months of infant age (postnatal).
* Complete Hammersmith Infant Neurological Examination (HINE), Developmental Assessment of Young Children 2 Edition (DAYC-2), and questionnaires / surveys at 22-26 months of infant age (postnatal).
* Permit data collection from electronic medical records for both the mother and infant study participants.

Investigators will compare DCC-120 vs. DCC-30 to see which approach is more beneficial to both the mother and baby with CHD.

Detailed Description

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* AIM 1: Test the hypothesis that, among neonates with prenatally diagnosed significant CHD (ranking of 3 - 6 on the Fetal Cardiovascular Disease Severity Score \[FCDSS\]), DCC-120 results in lower global rank score (GRS), indicative of better health outcomes, compared with DCC-30.
* AIM 2: Test the hypothesis that, among neonates with prenatally diagnosed significant CHD (ranking from 3 - 6 on the Fetal Cardiovascular Disease Severity Score \[FCDSS\]), DCC-120 will result in better neuromotor outcomes at 22-26 months postnatal than DCC-30.

Conditions

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Congenital Heart Disease (CHD)

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

SUPPORTIVE_CARE

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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Delayed Cord Clamping at 30 Seconds (DCC-30)

The umbilical cord will be clamped between 1 - \<60 seconds following delivery, with a goal of around 30 seconds.

Group Type ACTIVE_COMPARATOR

Umbilical Cord Clamping at ~30 seconds

Intervention Type PROCEDURE

Care team will wait to clamp the umbilical between 1-\<60 seconds after birth. 30 seconds is the ideal time of clamping.

Delayed Cord Clamping at 120 Seconds (DCC-120)

The umbilical cord will be clamped at 60 - 180- seconds following delivery, with a goal of around 120 seconds.

In the DCC-120 group, if there is concern for pregnant individual or baby and their doctor is not able to wait until at least 60 seconds, the doctor may do cord milking, which is four gentle squeezes of the umbilical cord pushing blood from the placenta to baby.

Group Type ACTIVE_COMPARATOR

Umbilical Cord Clamping at ~120 seconds

Intervention Type PROCEDURE

Care team will wait to clamp the umbilical cord between 60-180 seconds after birth.120 seconds is the ideal time of clamping

Umbilical Cord Milking

Intervention Type PROCEDURE

For infants who need their cord clamped before the target in the DCC-120 group. Care team may milk the umbilical cord towards the infant four times. Cord milking should NOT be performed if the delay meets or exceeds 60 seconds.

Umbilical cord milking will not be provided among participant-infant dyads in the DCC-30 group.

Interventions

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Umbilical Cord Clamping at ~30 seconds

Care team will wait to clamp the umbilical between 1-\<60 seconds after birth. 30 seconds is the ideal time of clamping.

Intervention Type PROCEDURE

Umbilical Cord Clamping at ~120 seconds

Care team will wait to clamp the umbilical cord between 60-180 seconds after birth.120 seconds is the ideal time of clamping

Intervention Type PROCEDURE

Umbilical Cord Milking

For infants who need their cord clamped before the target in the DCC-120 group. Care team may milk the umbilical cord towards the infant four times. Cord milking should NOT be performed if the delay meets or exceeds 60 seconds.

Umbilical cord milking will not be provided among participant-infant dyads in the DCC-30 group.

Intervention Type PROCEDURE

Other Intervention Names

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Randomized to DCC-30 Group Randomized to DCC-120 Group

Eligibility Criteria

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Inclusion Criteria

1. Fetal diagnosis of congenital heart disease (CHD) by prenatal ultrasound / echocardiography from local fetal ECHO, conducted on or after 18 weeks of gestation and prior to randomization. The study fetal diagnosis of CHD must be rated as 3 - 6 on the Fetal Cardiovascular Disease Severity Score (FCDSS), as determined by independent evaluators at the CORD-CHD trial ECHO Core at the Children's Hospital of Philadelphia (to determine final FCDSS eligibility for randomization).

For each potential participant that has provided consent, the most relevant diagnostic prenatal ultrasound will be uploaded (shared) between 32 weeks of gestation and randomization for review by the ECHO Core. The ECHO Core will make the final FCDSS determination for eligibility status and stratification assignment.\]

\[NOTE: A fetal diagnosis of CHD rated as 3 - 6 FCDSS per local review, including borderline cases, will be used to determine preliminary eligibility for consent. Among borderline cases, eligible patients will be included if there is a reasonable expectation of the need for surgery or cardiac catheterization during the birth hospitalization.\]
2. Singleton gestation.
3. Gestational age at randomization for impending deliveries between 37 0/7 - 41 6/7 weeks of gestation inclusive based on clinical information and evaluation of the earliest ultrasound determined using criteria proposed by the American Congress of Obstetricians and Gynecologists (ACOG), the American Institute of Ultrasound in Medicine and the Society for Maternal-Fetal Medicine.

\[NOTE: Pregnant individuals who were admitted to the delivery hospital prior to 37 0/7 weeks of gestation remain eligible to randomize, provided they deliver within the 37 0/7 and 41 6/7 weeks "eligibility window". Alternatively, if an eligible dyad is randomized at or just prior to 41 6/7 weeks, they remain in trial.\]
4. Consent for the participant and their infant

Exclusion Criteria

1. Pregnant individual is a gestational carrier or surrogate.
2. Compromise of the pregnant individual (e.g., vasa previa, placental accreta with hypotension, placental abruption, amniotic fluid embolism, uterine rupture, uterine inversion, disseminated intravascular coagulation), as determined by local care team

\[NOTE: There is no limitation on pregnant individual's age\]


1. Fetal demise or planned termination of pregnancy prior to randomization
2. Tachyarrhythmia requiring transplacental therapy
3. Fetal hydrops, severe
4. Planned fetal surgery
5. Diaphragmatic hernia, omphalocele, gastroschisis, intestinal atresia
6. Major chromosomal defects (e.g., Trisomy 13, 18) identified prenatally; Trisomy 21 is allowed
7. Disease or disorder impacting candidacy for neonatal cardiac interventions
8. Parents choosing to limit treatment


1. Delivery planned at an institution not affiliated with or does not refer to a CORD-CHD participating site
2. Participation in another prenatal interventional study that influences cord clamping or perinatal morbidity or mortality
Minimum Eligible Age

37 Weeks

Maximum Eligible Age

42 Weeks

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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The George Washington University Biostatistics Center

OTHER

Sponsor Role collaborator

National Heart, Lung, and Blood Institute (NHLBI)

NIH

Sponsor Role collaborator

Emory University

OTHER

Sponsor Role collaborator

Boston Children's Hospital

OTHER

Sponsor Role collaborator

University of Bristol

OTHER

Sponsor Role collaborator

Geisinger Commonwealth School of Medicine

UNKNOWN

Sponsor Role collaborator

Duke University

OTHER

Sponsor Role collaborator

Children's Hospital of Philadelphia

OTHER

Sponsor Role collaborator

Sharp Mary Birch Hospital for Women & Newborns

OTHER

Sponsor Role collaborator

Université de Montréal

OTHER

Sponsor Role collaborator

Carl Backes, MD

OTHER

Sponsor Role lead

Responsible Party

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Carl Backes, MD

Principal Investigator

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Carl Backes, MD

Role: PRINCIPAL_INVESTIGATOR

Nationwide Children's Hospital

Anup Katheria, MD

Role: PRINCIPAL_INVESTIGATOR

Sharp Mary Birch Hospital for Women & Newborns

Kevin Hill, MD

Role: PRINCIPAL_INVESTIGATOR

Duke Children's Hospital

Madeline Rice, PhD

Role: PRINCIPAL_INVESTIGATOR

George Washington University Biostatistics Center

Grecio (Greg) Sandoval, PhD

Role: PRINCIPAL_INVESTIGATOR

George Washington University Biostatistics Center

Scott Evans, PhD

Role: PRINCIPAL_INVESTIGATOR

George Washington University Biostatistics Center

Locations

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Children's of Alabama

Birmingham, Alabama, United States

Site Status RECRUITING

Cedars-Sinai Medical Center

Los Angeles, California, United States

Site Status RECRUITING

Children's Hospital of Orange County

Orange, California, United States

Site Status NOT_YET_RECRUITING

Lucile Packard Children's Hospital Stanford

Palo Alto, California, United States

Site Status NOT_YET_RECRUITING

Sharp Mary Birch Hospital for Woman and Newborns

San Diego, California, United States

Site Status RECRUITING

UF Health Shands Children's Hospital

Gainesville, Florida, United States

Site Status RECRUITING

Johns Hopkins Children's Center

Baltimore, Maryland, United States

Site Status RECRUITING

Children's of Mississippi

Jackson, Mississippi, United States

Site Status RECRUITING

The Children's Mercy Hospital

Kansas City, Missouri, United States

Site Status RECRUITING

SSM Health Cardinal Glennon Children's Hospital

St Louis, Missouri, United States

Site Status RECRUITING

Duke Children's Hospital & Health Center

Durham, North Carolina, United States

Site Status RECRUITING

Nationwide Children's Hospital

Columbus, Ohio, United States

Site Status RECRUITING

Children's Hospital of Philadelphia

Philadelphia, Pennsylvania, United States

Site Status RECRUITING

Medical University of South Carolina

Columbia, South Carolina, United States

Site Status RECRUITING

Monroe Carell Jr. Children's Hospital at Vanderbilt

Nashville, Tennessee, United States

Site Status RECRUITING

Texas Children's Hospital

Houston, Texas, United States

Site Status RECRUITING

University of Texas Health Science Center at San Antonio

San Antonio, Texas, United States

Site Status RECRUITING

Primary Children's Hospital

Salt Lake City, Utah, United States

Site Status RECRUITING

Stollery Children's Hospital, University of Alberta

Edmonton, Alberta, Canada

Site Status RECRUITING

IWK Health Centre

Halifax, Nova Scotia, Canada

Site Status RECRUITING

The Hospital for Sick Children

Toronto, Ontario, Canada

Site Status NOT_YET_RECRUITING

Countries

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United States Canada

Central Contacts

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Carl Backes, MD

Role: CONTACT

614-355-6729

Chelsea E Cobe, BA

Role: CONTACT

614-355-6651

Facility Contacts

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Andrea Kane, MD

Role: primary

Ruchira Garg, MD

Role: primary

Shawn Sen, MD

Role: primary

Alexis Davis, MD

Role: primary

Anup Katheria, MD

Role: primary

Jenny Koo, MD

Role: backup

Jennifer Co-Vu, MD

Role: primary

Victoria Surma, MD

Role: primary

Simon Karam, MD

Role: primary

John Daniel, MD

Role: primary

Justin Josephsen, MD

Role: primary

Kevin Hill

Role: primary

Carl H. Backes, MD

Role: primary

6142646374

Elizabeth Foglia, MD

Role: primary

Sinai Zyblewski, MD

Role: primary

Prince Kannankeril, MD

Role: primary

Nathan Sundgren, MD, PhD

Role: primary

J.B. Cantey, MD

Role: primary

Ryan Carpenter, MD

Role: primary

Brenda Law, MD

Role: primary

Walid El-Naggar, MD

Role: primary

Michael Seed, MBBS

Role: primary

References

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Marzec L, Zettler E, Cua CL, Rivera BK, Pasquali S, Katheria A, Backes CH. Timing of umbilical cord clamping among infants with congenital heart disease. Prog Pediatr Cardiol. 2020 Dec;59:101318. doi: 10.1016/j.ppedcard.2020.101318. Epub 2020 Oct 28.

Reference Type BACKGROUND
PMID: 34113067 (View on PubMed)

Backes CH, Huang H, Cua CL, Garg V, Smith CV, Yin H, Galantowicz M, Bauer JA, Hoffman TM. Early versus delayed umbilical cord clamping in infants with congenital heart disease: a pilot, randomized, controlled trial. J Perinatol. 2015 Oct;35(10):826-31. doi: 10.1038/jp.2015.89. Epub 2015 Jul 30.

Reference Type BACKGROUND
PMID: 26226244 (View on PubMed)

Fite EL, Rivera BK, McNabb R, Smith CV, Hill KD, Katheria A, Maitre N, Backes CH. Umbilical cord clamping among infants with a prenatal diagnosis of congenital heart disease. Semin Perinatol. 2023 Jun;47(4):151747. doi: 10.1016/j.semperi.2023.151747. Epub 2023 Mar 18. No abstract available.

Reference Type BACKGROUND
PMID: 37002126 (View on PubMed)

Other Identifiers

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UG3HL166794

Identifier Type: NIH

Identifier Source: secondary_id

View Link

UG3HL166799

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

STUDY00003337

Identifier Type: -

Identifier Source: org_study_id

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