99 Deferred cord clamping in very and extremely preterm monochorionic twins: A retrospective cohort study
Bibliographic record
Abstract
Abstract Background The rate of multiple births has surged. Twins, especially those with monochorionic placentation, face a higher risk of neonatal mortality, morbidity and very preterm birth compared to singletons. Deferred cord clamping (DCC) is the standard for preterm singletons. While DCC is known to reduce the risk of mortality and morbidity in preterm singletons, its efficacy and safety in very preterm twins, especially monochorionic twins, remain scarcely explored. Objectives This study aimed to assess whether DCC, compared with early cord clamping (ECC), was associated with a reduction in death and/or severe brain injury in very and extremely preterm monochorionic-diamniotic twins. Design/Methods This multicenter retrospective cohort study included liveborn monochorionic-diamniotic twins of <32 gestational weeks admitted to a tertiary-level neonatal intensive care unit (NICU) in Canada between 2018 and 2023 using the Canadian Neonatal/Preterm Birth Network (CNN/CPTBN) database. We compared DCC ≥30s and ECC <30s. The primary outcome was a composite of death before discharge and/or severe brain injury. Secondary outcomes included neonatal morbidity and clinical outcomes. We calculated crude odds ratios (ORs) and adjusted ORs for categorical variables and ratio of means for continuous variables, along with 95% confidence intervals (CI). Models were fitted with generalized estimated equations accounting for twin correlation. Results 1017 neonates were included (DCC 488 [48.0%]; ECC 529 [52.0%]). Death and/or severe brain injury occurred in 10% (n=48) of twins who received DCC and in 16% (n=82) of those who received ECC. There was no significant difference between the groups (aOR 0.93; 95% CI 0.60-1.45). There was a significant reduction in red blood cell transfusions (aOR 0.46; 95% CI 0.33-0.66). Conclusion Among monochorionic-diamniotic twins born before 32 weeks of gestation, DCC did not impact the incidence of death and/or severe brain injury compared to ECC but was associated with decreased need for transfusions.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".