Deferred cord clamping in very and extremely preterm monochorionic twins: A retrospective cohort study.

Authors

Andréanne Villeneuve, Morgane St-Pierre Lanthier, François Audibert, Stephanie Klam, Haim Abenhaim, Sarah D McDonald, Marc Beltempo, Canadian Preterm Birth Network and Canadian Neonatal Network investigators, CPTBN Site Investigators

Published in

Pediatrics and neonatology. Jul 23, 2026. Epub Jul 23, 2026.

Abstract

To assess whether deferred cord clamping (DCC) is associated with reduced death and/or severe brain injury compared to early cord clamping (ECC) in very and extremely preterm monochorionic-diamniotic (MCDA) twins.
This multicenter retrospective cohort study included liveborn MCDA twins born under 32 weeks of gestation and admitted to any tertiary-level neonatal intensive care unit (NICU) participating in the Canadian Neonatal Network (CNN) in Canada between 2018 and 2023. We compared DCC ≥30s to ECC<30s. The primary composite outcome was death before discharge and/or severe brain injury (intraventricular hemorrhage ≥ grade III and/or cystic periventricular leukomalacia). Secondary outcomes included neonatal morbidities and interventions. Adjusted odds ratios (aORs) for categorical variables and ratio of means for continuous variables were estimated with 95% confidence intervals (CIs). Generalized estimating equation (GEE) models accounted for the correlation between twins.
Approximately 42% of first-born and 54% of second-born MCDA twins received DCC. The primary composite outcome of death and/or severe brain injury occurred in 10% (48/488) of twins who received DCC and 16% (82/529) of those who received ECC (aOR 0.93; 95% CI 0.60-1.45). Among secondary outcomes, there were no significant differences in neonatal morbidities or interventions, except for a significant reduction in red blood cell transfusions, with 24% (115/488) of twins in the DCC group receiving at least one transfusion versus 43% (229/529) in the ECC group (aOR 0.46; 95% CI 0.33-0.66).
Among MCDA twins born at < 32 gestational weeks, DCC did not impact the risk of death and/or severe brain injury compared to ECC but it was associated with decreased need for transfusions.

PMID:
42580916
Bibliographic data and abstract were imported from PubMed on 12 Aug 2026.

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