Clinical Trial Proves Fast, Effective and Free Treatment Saves Babies' Lives

The Australian Placental Transfusion Study (APTS) of babies born before 37 weeks’ gestation proved that a one minute delay in clamping of the umbilical cord saves babies’ lives, reducing the relative risk of death in hospital by a third.

“The trial is of exceptional standard, addresses a critical gap in evidence, and will significantly improve premature infant health outcomes,” said ACTA Chair, Professor John Zalcberg.

The trial, the results of which were published in the New England Journal of Medicine last year, was led by Professor of Neonatology William Tarnow-Mordi, from the NHMRC Clinical Trials Centre at University of Sydney.

He described the award as a tribute to the many hundreds of parents, nurses, doctors, researchers, funders and managers who have been involved in the trial over the last decade.

“It took us more than ten years to plan and complete the APTS,” said Professor Tarnow-Mordi. “And if we’d had the answer to that trial even three years earlier then thousands of babies around the world could have been saved.”

“What the APTS experience highlights is both the value of clinical trials and the importance of making them happen faster. Our vision in the future is to enrol ten times as many patients, ten times as fast and at a tenth of the cost.”

“The key will be embedding trials in routine care, using digital technology, point of care data capture and embracing a culture of partnership with parents, policymakers and health professionals across the health system.”

Co-chair and second author of APTS, University of Sydney Professor Jonathan Morris of Royal North Shore Hospital, said the findings of the trial were important and likely to be extremely impactful.

“This intervention is simple and can be applied in every setting where babies are born across the world. This research will save lives.”

The first evidence was published in the Australian Placental Transfusion Study in the New England Journal of Medicine in 2017, indicating that delayed umbilical cord clamping might have benefits for preterm infants and their mothers. This was confirmed in a systematic review of randomised trials in nearly 3,000 preterm babies published in the American Journal of Obstetrics and Gynaecology.

The Australian Placental Transfusion Study was the largest of the trials, involving nearly 1,600 babies born more than ten weeks early in 25 hospitals in seven countries.

In that trial, doctors either clamped the cord within ten seconds of birth or aimed to wait 60 seconds before clamping.

“Ten years ago, umbilical cords were routinely clamped quickly after a preterm birth and the baby was passed to a paediatrician in case s/he needed urgent help with breathing,” says Professor Tarnow-Mordi.

“But we now know that almost all preterm babies will start breathing by themselves in the first minute, if they are given time.”

“During this minute, babies may get extra red and white blood and stem cells from the placenta, helping to achieve healthy oxygen levels, control infection and repair injured tissue.”

“Because they get more time to start breathing on their own, it helps avoid invasive procedures. It also means that fewer babies get blood transfusions, and there is no increase in complications for mother or baby.”

Professor Tarnow-Mordi says the benefits of the evidence are huge because, world-wide, 15 million babies are born preterm each year.

“Fast, effective treatments that cost nothing are rare, but the evidence shows that delayed cord clamping is one of them.”

“For babies who don’t need immediate resuscitation the message is simple – wait a minute!”