Bilirubin Levels in Neonates ≥35 Weeks of Gestation Receiving Delayed Cord Clamping for an Extended Time—An Observational Study

Abstract

To describe bilirubin levels in neonates ≥350/7 gestational weeks, receiving delayed cord clamping (CC), in relation to the updated Bhutani nomogram. This was a retrospective, observational study based on data from medical records and local data sheets. Singleton neonates, born vaginally at a gestational age ≥350/7, and with a registered time to CC and at least one registered bilirubin, were included. We excluded neonates with positive direct antiglobulin test or hemolytic disorders. Adjusted analyses were performed using ANOVA and linear or logistic regression. We analyzed 558 neonates, mean gestational age (SD) 39.9 (1.3) weeks. CC was performed at a median (IQR) time of 6 (5-8) minutes. The dataset contained 1330 bilirubin measurements. Median (IQR) age at bilirubin measurement was 37 (22-54) hours. Bilirubin percentiles in neonates with CC time ≥2minutes were similar, or lower, compared with the Bhutani nomogram between 12 and 72hours, but with greater 95th percentile at later hours of age. Phototherapy was initiated in 13 (2.3 %) of the neonates. We found no association between time to CC and hyperbilirubinemia (β=-0.05, P=.07). Need for phototherapy was marginally greater in neonates with shorter time to CC. Bilirubin levels were not correlated to time to CC. Our findings indicate that CC beyond 2minutes can be performed without additional monitoring for jaundice.