Timing of umbilical cord clamping for preterm infants in low-and-middle-income countries: A survey of current practice

Abstract

IntroductionThe optimal timing of umbilical cord clamping in preterm infants has been contested for years. Previously, it was common practice to clamp the cord immediately after birth. There is now high-quality evidence that delayed cord clamping (DCC) (>60 seconds) reduces mortality in preterm infants by allowing placental transfusion. However, it is unclear how well DCC has been implemented into practice. This study aims to assess current practice of timing of cord clamping for both stable and unstable preterm infants in LMICs, where rates of preterm birth and neonatal mortality are high and where there is the potential to see the greatest benefit from implementation of DCC. MethodsAn online survey was created and, following user-testing, circulated to maternity workers in LMICs via The International Federation of Gynaecology and Obstetrics (FIGO), social media and other existing collaborators. Analyses were conducted using SPSS. Results70 responses were received across 10 LMICs. 42/70 (60%) participants reported practising DCC for stable preterm infants, compared to only 4/70 (6%) for unstable infants. For stable infants, 22/42 (52%) of those who practised DCC gave their main reason as being “recommended by guidelines”. 13/70 (19%) participants said they didn’t follow any guidelines for the timing of cord clamping. Only 25/70 (36%) were aware of guidelines for cord clamping in their hospitals, and 9/70 (13%) were aware of related quality improvement projects (QIPs). DiscussionDespite evidence to support the use of DCC, timing of cord clamping in LMICs is variable. Unstable infants requiring stabilisation could benefit most from placental transfusion, yet few respondents practised DCC and few hospitals had QIPs in place. Higher-quality guidelines and training could increase implementation of DCC, and development of affordable equipment to allow bedside resuscitation with the cord intact could aid in reducing neonatal mortality.