# 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)

## TL;DR

This study found that delayed cord clamping in extremely premature babies did not reduce kidney injury but was linked to lower kidney function at two years.

## Contribution

The study provides new insights into the long-term kidney outcomes of delayed cord clamping in extremely preterm neonates.

## Key findings

- Delayed cord clamping did not reduce the incidence or severity of acute kidney injury.
- Delayed cord clamping was associated with a 4.5-fold higher adjusted odds of reduced eGFR at two years.
- No significant associations were found between delayed cord clamping and albuminuria or elevated blood pressure.

## Abstract

Delayed cord clamping (DCC) occurs in most preterm births.

Evaluate the association of DCC with acute kidney injury (AKI) and two-year kidney outcomes.

Secondary analysis of the Preterm Erythropoietin Neuroprotection Trial of neonates born 240/7 to 276/7 weeks’ gestation. AKI and two year kidney outcomes were compared in neonates with DCC (≥30 seconds after delivery) to those with early cord clamping (ECC) (<30 seconds after delivery).

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 times increased adjusted odds of eGFR <90 mL/min/1.73m2. No significant associations were noted between DCC and albuminuria or elevated BP.

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.