Professor University of Utah Salt Lake City, Utah, United States
Background: Data regarding neurodevelopmental outcomes based on umbilical cord management at birth is currently limited. In 2014, the Intermountain Health Care System (IHC) recommended umbilical cord milking (UCM) x 3 for all infants born ≤28 weeks gestation. With new evidence, in October 2020, IHC revised this recommendation to delayed cord clamping (DCC) for 30-60 seconds. Infants ≤28 weeks are routinely followed in the high-risk follow-up clinic. In the clinic, the Hammersmith Infant Neurological Examination (HINE) is administered at the 3 and 9-month visits. The HINE is a scorable standardized neurological examination to assess infants. It includes 26 items assessing cranial nerves, posture, movement, tone, and reflexes. Objective: This study aims to describe HINE scores at 3 and 9 months of age for infants born ≤28 weeks based on their mode of umbilical cord management. Design/Methods: Retrospective analysis of infants born ≤28 weeks gestational age in a previously established IHC cord management database between January 2018 and January 2022 at 14 delivery hospitals in the IHC system. Infants were included if they received a HINE assessment through the neonatal follow-up clinic. Descriptive statistics and one-way ANOVA testing were utilized to evaluate differences in HINE testing results based on umbilical cord management at birth (PRISM v10). Results: During the UCM era (2018 to 2020), 54% of preterm infants received UCM, 11% received DCC, and 35% received immediate cord clamping (ICC) at 14 delivery hospitals in the IHC system. After the change in policy to DCC (2020 to 2022), 2% of preterm infants received UCM, 64% received DCC, and 33% received ICC. We identified 149 infants with HINE testing following hospital discharge (table 1). Of these infants, 48 received DCC, 53 received ICC, and 48 received UCM. A total of 128 infants received HINE during their 3-month follow-up visit with an average adjusted age of 4.3 months; there was no significant difference in HINE scores based on cord management at delivery (p = 0.82). A total of 102 infants received the HINE at their 9-month follow-up visit with an average adjusted age of 9.7 months; there was no significant difference in HINE scores based on cord management at delivery (p=0.43).
Conclusion(s): In infants born ≤28 weeks gestational age, there was no significant difference in HINE scores at the 3-month or 9-month follow-up visit based on the cord management method at delivery. Our team plans to conduct further analyses to evaluate differences in additional developmental outcomes at older corrected gestational ages based on umbilical cord management.
3 Month and 9 Month Hammersmith Infant Neurological Examination Scores by Method of Umbilical Cord Management DCC HINE PAS 2025 table 1.pdf
