Edmonton has recruited the 1st patient for the CORD-CHD-Trial

Cord Clamping Among Neonates With Congenital Heart Disease (CORD-CHD)

Introduction

In neonatal care, the timing of umbilical cord clamping (UCC) plays a crucial role in an infant’s immediate and long-term health outcomes, especially for those with congenital heart disease (CHD). For term-born infants diagnosed prenatally with CHD, the timing of UCC can have significant impacts on both health and neuromotor development. A recent clinical trial, titled CORD-CHD (Clamp OR Delay Among Neonates with Congenital Heart Disease), seeks to explore the effects of two different delayed cord clamping timepoints to determine the best approach for these vulnerable infants.

Study Overview

The CORD-CHD trial is designed to compare Delayed Cord Clamping at 120 seconds (DCC-120) with Delayed Cord Clamping at 30 seconds (DCC-30). The researchers are investigating whether these timing variations result in different health and neuromotor outcomes for infants with significant CHD. The study also seeks to understand if DCC-120 or DCC-30 offers any benefits for the mothers involved in the trial.

Main Questions the Study Aims to Answer

Immediate Health Outcomes: Does waiting 120 seconds before clamping the umbilical cord lead to better health outcomes compared to waiting only 30 seconds?
Neuromotor Development: Does DCC-120 promote improved neuromotor outcomes by 22-26 months of age compared to DCC-30?

By observing these outcomes, the study hopes to provide data-driven guidance on the optimal timing of umbilical cord clamping for infants with CHD.

Participant Involvement

Infants participating in the study are randomly assigned to one of the two delayed cord clamping timepoints (DCC-120 or DCC-30). Parents and caregivers are asked to follow up at specific postnatal intervals to provide essential developmental data:

3-4 Months Postnatal: Complete the General Movements Assessment (GMA) and respond to questionnaires.
9-12 Months Postnatal: Complete additional questionnaires.
22-26 Months Postnatal: Complete a set of comprehensive assessments, including the Hammersmith Infant Neurological Examination (HINE), the Developmental Assessment of Young Children (DAYC-2), and other surveys.
Ongoing Data Collection: Allow access to electronic medical records to monitor both the mother’s and infant’s health.

Detailed Study Aims

The trial has two primary aims, each of which addresses a specific hypothesis regarding the impact of DCC on neonates with CHD:

AIM 1: For infants with significant CHD (Fetal Cardiovascular Disease Severity Score of 3-6), the researchers hypothesize that DCC-120 will yield a lower global rank score (GRS), reflecting better overall health outcomes, compared to DCC-30.
AIM 2: In the same CHD group, it is hypothesized that DCC-120 will lead to better neuromotor outcomes by 22-26 months of age compared to DCC-30.

Procedures and Interventions

In this study, umbilical cord clamping and cord milking are the primary interventions being tested:

Umbilical Cord Clamping at 30 seconds: A relatively early cord clamping, aimed at reducing possible risks associated with prolonged delay.
Umbilical Cord Clamping at 120 seconds: Allows additional time for blood transfer, which may benefit infants with CHD.
Umbilical Cord Milking: Involves manually pushing blood through the cord to the infant to increase blood volume, potentially useful in infants with certain health conditions.

The Importance of This Study

For infants with CHD, determining the optimal timing for umbilical cord clamping could enhance health outcomes significantly, reducing risks associated with immediate health and improving long-term neuromotor development. This trial provides a much-needed exploration into these variations, and its findings may guide future neonatal care practices, potentially improving outcomes for both infants with CHD and their families.

Stay tuned as we learn more about this promising study and the future of neonatal care for infants with congenital heart disease!