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ABC3 reveals benefits for both parents and infant
The ABC3 trial, which has been published today, reveals benefits for both parents and infant, further supporting Physiological-Based Cord Clamping as a valuable and safe approach that aligns with the goal of zero separation at birth. The reported significant positive outcomes in favor of Physiological-Based Cord Clamping (PBCC) compared to Time-Based Cord Clamping (TBCC) include:
- It is safe for mother and infant
- Improvement in intact survival in male infants of 11% (relative redution)
- A more stable cardiopulmonary transition, with a 1:44 min shorter time to stabilize
- Fewer red blood cell transfusions (7% relative reduction) and lower incidence of late onset sepsis (18% relative reduction)
- Intact survival improved as the number procedures in a participating center increased
- Parents were less anxious and more content
The ABC3 trial is a multicenter RCT conducted in all Dutch tertiary referral centers for perinatal care, involving infants born before 30 gestation. The trial aims to research the benefits of Physiological-Based Cord Clamping. In total 669 infants were randomized to either PBCC or 30-60 sec TBCC. PBCC resulted in a mean cord clamping time of 5:47. This trial is the first trial using criteria for cord clamping based on the infant’s clinical condition with DCC as comparison.
The results show an increase of intact survival of 4,5% in the entire cohort (per-protocol analysis), the study was underpowered to demonstrate a significant difference. Interestingly, a significant increase in intact survival in male infants receiving PBCC was demonstrated. It is known that male infants have more difficulty going through transition at birth, need resuscitation more often and have worse outcomes when born prematurely.
In this trial, infants in the PBCC group received fewer red blood cell transfusions. It is possible that PBCC infants were more stable during admission, resulting in fewer complications and interventions, and fewer blood samples. This is consistent with the finding that PBCC led to a significant decrease in late onset sepsis.
Of all participating Dutch centers, two centers had gained prior experience with the PBCC approach before the trial start. Evaluating the effect of experience, improved intact survival was achieved as the number procedures in a participating center increased. This finding stresses the importance of appropriate training as well as obtaining experience, when implementing PBCC.
An important benefit reported in this study is the bonding that is facilitated between mother and child. Differences between the groups were observed for: contentedness with the approach, degree of anxiety, the visibility of the infant, degree of convenience and the safety for mother and child, all scoring better in the PBCC group. This data suggests that PBCC is a valuable and safe approach, supporting zero separation between mother and infant at birth. The authors support the further development of PBCC in this regard.
The ABC3 trial confirms that PBCC is a valuable and safe approach, showing benefits for both parents and infant. We invite you all to explore and discuss the study’s findings and join our next Concord Talk: ABC project latest evidence and key findings - by initiator and lead investigator Professor Arjan te Pas.
At Concord Neonatal, we believe that keeping mother and baby together from the moment of birth is a fundamental right. Join us in advancing the clinical development of PBCC towards a future where breaking the bond between baby and mom is a practice of the past.
Click here for the complete article, published in The Lancet Regional Health Europe.
