Cord Clamping In Term Infants Research Articles

Comparison of the Frequency of Neonatal Anemia in Early Versus Delayed Cord Clamping in Babies at Term

Aim: To compare frequency of the anemia in neonates in early versus delayed umbilical cordclamping in term infants. Study design: Randomized controlled trial. Place and duration of study: Department of Obstetrics & Gynecology, Divisional Headquarters Hospital Mirpur AJK from 30th January 2021 to 29th July 2021. Methodology: The study enrolled 96infants which were delivered at term within the gestational range of 37-41 weeks (as assessed on LMP). Those infants who were born to diabetic, sepsis mother or with inborn metabolic errors, jaundice neonatorum or Rh incompatibility and PROM were excluded from the study. Then selected women were placed randomly into two equal groups i.e. Group A (early cord clamping) & Group B(delayed cord clamping) by lottery method. Respective group selection was performed through randomization. In group a neonates, early cord clamping (cord clamping within 15 seconds of birth) was done while in group B neonates, delayed cord clamping (cord clamping after 3 minutes of birth) was done. In both groups, blood sample of all infants was sent after 6 hours of birth for hematocrit level measurement and neonatal anemia was noted. Results: The mean age in years of patients in group A was calculated as 26.52±5.17 while in group B it was calculated as 27.17±3.89. The age of 80.21% patients was within 18 to 30 years and the mean gestational age was determined as 39.23±1.48 weeks. The mean gestational age in group A was 39.25±1.48 weeks and in group B was 39.21±1.49 weeks. Frequency of neonatal anemia in group A (early cord clamp) versus group B (delayed umbilical cord clamping) was 11 (22.92%) and 04 (8.33%) respectively with p-value of 0.049. Practical Implication: we recommend that delayed umbilical cord clamping should be preferred in our routine practice for prevention of neonatal anemia. Conclusion: This study concluded that the neonatal anemia is high after early cord clamping in infants at term as compared to delayed cord clamping Keywords: Cord Clamping, Delayed, Anemia.

The Effect of Different Timings of Delayed Cord Clamping of Term Infants on Maternal and Newborn Outcomes in Normal Vaginal Deliveries.

Background and objectiveDelayed cord clamping (DCC) has proven to be an ideal approach to reduce iron deficiency anemia; however, different timings of DCC relative to the birth outcome lead to conflicting results. The present study was conducted to determine the effects of different timings of DCC on the maternal and neonatal outcomes in normal vaginal deliveries at term.MethodsThis was an interventional study on neonates born at term without complications to mothers with uneventful pregnancies in the labor unit of a district hospital in Odisha, India. A total of 147 women were randomized to three intervention groups: DCC at one minute, DCC at two minutes, and DCC at three minutes. Hemoglobin and bilirubin levels, maternal blood loss, the timing of the third stage of labor, oxytocin use, and birth weight of the neonates were measured as the outcomes of different timings of DCC.ResultsAt 24-48 hours of age, hemoglobin and bilirubin levels of the neonates were significantly higher with DCC at three minutes compared to DCC at one and two minutes. However, there were no significant differences among the three groups in terms of the need for phototherapy. The duration of the third stage of labor was significantly longer with DCC at three minutes. Maternal blood loss, oxytocin use, and birth weight of the neonates were not significantly associated with the timing of DCC.ConclusionBased on our findings, waiting to clamp the umbilical cord until three minutes can effectively reduce the incidence of iron deficiency anemia in newborns.

Delayed Umbilical Cord Clamping After Birth: ACOG Committee Opinion Summary, Number 814.

Delayed umbilical cord clamping appears to be beneficial for term and preterm infants. In term infants, delayed umbilical cord clamping increases hemoglobin levels at birth and improves iron stores in the first several months of life, which may have a favorable effect on developmental outcomes. There is a small increase in the incidence of jaundice that requires phototherapy in term infants undergoing delayed umbilical cord clamping. Consequently, obstetrician-gynecologists and other obstetric care providers adopting delayed umbilical cord clamping in term infants should ensure that mechanisms are in place to monitor and treat neonatal jaundice. In preterm infants, delayed umbilical cord clamping is associated with significant neonatal benefits, including improved transitional circulation, better establishment of red blood cell volume, decreased need for blood transfusion, and lower incidence of necrotizing enterocolitis and intraventricular hemorrhage. Delayed umbilical cord clamping was not associated with an increased risk of postpartum hemorrhage or increased blood loss at delivery, nor was it associated with a difference in postpartum hemoglobin levels or the need for blood transfusion. Given the benefits to most newborns and concordant with other professional organizations, the American College of Obstetricians and Gynecologists now recommends a delay in umbilical cord clamping in vigorous term and preterm infants for at least 30-60 seconds after birth. The ability to provide delayed umbilical cord clamping may vary among institutions and settings; decisions in those circumstances are best made by the team caring for the mother-infant dyad.

Delayed Umbilical Cord Clamping After Birth: ACOG Committee Opinion, Number 814.

Delayed umbilical cord clamping appears to be beneficial for term and preterm infants. In term infants, delayed umbilical cord clamping increases hemoglobin levels at birth and improves iron stores in the first several months of life, which may have a favorable effect on developmental outcomes. There is a small increase in the incidence of jaundice that requires phototherapy in term infants undergoing delayed umbilical cord clamping. Consequently, obstetrician-gynecologists and other obstetric care providers adopting delayed umbilical cord clamping in term infants should ensure that mechanisms are in place to monitor and treat neonatal jaundice. In preterm infants, delayed umbilical cord clamping is associated with significant neonatal benefits, including improved transitional circulation, better establishment of red blood cell volume, decreased need for blood transfusion, and lower incidence of necrotizing enterocolitis and intraventricular hemorrhage. Delayed umbilical cord clamping was not associated with an increased risk of postpartum hemorrhage or increased blood loss at delivery, nor was it associated with a difference in postpartum hemoglobin levels or the need for blood transfusion. Given the benefits to most newborns and concordant with other professional organizations, the American College of Obstetricians and Gynecologists now recommends a delay in umbilical cord clamping in vigorous term and preterm infants for at least 30-60 seconds after birth. The ability to provide delayed umbilical cord clamping may vary among institutions and settings; decisions in those circumstances are best made by the team caring for the mother-infant dyad.

Umbilical cord milking versus delayed cord clamping in term infants: a systematic review and meta-analysis.

Delayed cord clamping (DCC) is recommended for healthy term infants. However, the effectiveness of umbilical cord milking (UCM) in term infants remains unknown. The study aimed to compare the effects of UCM versus DCC on term infants. A systematic review and meta-analysis were conducted which included individual and clustered RCTs comparing UCM with DCC for infants born at ≥37 weeks of gestation. Three trials (650 term infants) were included. Compared with DCC, UCM was associated with higher hemoglobin levels at 6 weeks after birth [infants, 621; mean difference, 0.17; 95% confidence interval, 0.05-0.29] and had no statistical differences in hemoglobin levels at birth, serum bilirubin levels at 48 h after birth, or hematocrit levels at 48 h after birth. This study suggested that UCM might be as beneficial as DCC in term infants, however, further RCTs are required to accurately assess the outcomes.

A randomized controlled study of immediate versus delayed umbilical cord clamping in infants born by elective caesarean section

BackgroundDelayed umbilical cord clamping is associated with greater haemoglobin concentration and iron storage between 3 and 6 months of life and with less need of blood transfusion and lower incidence of neonatal hypotension compared to early umbilical cord clamping.MethodsThe aim was to test the hypothesis that delayed cord clamping is better than early cord clamping in term infants born by elective caesarean section. Group A was subjected to immediate cord clamping while in the Group B, the umbilical cord was clamped 1 min after birth. Primary aim was revealed the difference in pre-ductal saturation between two groups while secondary aim was investigating the difference in HR, Ht, bilirubin and glycaemia. Pre-ductal SpO2 and HR were recorded at 5 and 10 min after birth, T was analysed 10 min after birth, glycaemia was revealed at 120 min while Ht and bilirubin were collected at 72 h.Results132 newborns were enrolled in the study and allocated in ratio 1:1 to group A or B. Delayed cord clamping did not improve SpO2, HR and T values compared to immediate cord clamping (p > 0,05). However, Group B showed greater haematocrit and bilirubin values at 72 h compared to Group A (56,71 ± 6663 vs 51,56 ± 6929; p < 0,05 and 8,54 ± 2,90 vs 7,06 ± 2,76; p < 0,05). Glycaemia value did not differ between two groups (p > 0,05).ConclusionsGroup B did not reveal any differences in SpO2, HR, T and glycaemia compared to Group A. Group B showed greater values of haematocrit and bilirubin but without need of phototherapy.Trial registrationUmbilical Cord Clamping: What Are the Benefits; NCT03878602. Registered 18 March 2019 retrospectively registered.

Effect of Early versus Late Cord Clamping of Term Infants on Maternal and Neonatal Outcomes

Aim: The current study aimed to study the effect of early versus late cord clamping of term infants on maternal and neonatal outcomes. Design: A quasi-experimental study design was used. Setting : Labour ward affiliated at Obstetrics and Gynecology department at Benha University Hospital. Sampling: Purposive sample included 340 women divided into 2 equal groups (group1 early cord clamping and group2 late cord clamping).Tools of data collection: I-Structured interviewing questionnaire sheet consisted of two parts. II- Maternal outcomes measures. III- Neonatal outcomes measures. Result. There was no statistical significant difference between early and late cord clamping regarding the duration of different stages of labor and postpartum laboratory investigation findings including maternal hemoglobin level and hematocrit at birth, and after four hours. There was a highly statistical significant difference ( p 0.05) between both groups regarding total bilirubin after 4 hours. Conclusion: delayed cord clamping improves neonatal hemoglobin and ferritin levels without causing any harm to maternal or neonatal outcomes. Also delayed cord clamping doesn't increase postpartum hemorrhage or duration of third stage of labour. Recommendation: increasing awareness of the routine delayed cord clamping by obstetricians and midwives to achieve mothers and neonates benefit.

Effects of umbilical cord milking compared to differed cord clamping in term infants, a randomized controlled trial

Introduction: Differed cord clamping (DCC) at delivery is currently recommended to increase neonatal haemoglobin levels (Hb) and reduce the risk of infant anemia. It needs waiting for two to three minutes, which is considered to be associated with most of its unwanted effects. An alternative could be umbilical cord milking (UCM) with early clamping. Although effects of UCM have been assessed in preterm neonates such evidence is sparse for term neonates. Objectives: To evaluate whether the effects on Hb, bilirubin and haemodynamic parameters in infants, and blood loss in the mother are better with UCM than with DCC during elective caesarean delivery at term. Methods: Sixty term pregnant mothers undergoing elective caesarean delivery (CD) in Teaching Hospital Kandy, from 1st February to 31st March 2015 were randomized to UCM and DCC. The UCM group had the umbilical cord milked towards the umbilicus of the baby in a standard method soon after delivery. The DCC group had the umbilical cord clamped after two minutes of delivery or once the cord pulsations had ceased. Neonatal Hb, bilirubin and haemodynamic parameters, and maternal blood loss were assessed within 48 hours of delivery. Results: Thirty three participants underwent UCM while 27 participants underwent DCC. Main indications for the CD were past CD (47%), failed induction (12%), past bad obstetric history (10%), maternal medical conditions (8%) and suspected gross cephalo pelvic disproportion (8%). All CD were performed under spinal aneasthesia. There were no significant differences between the UCM and DCC groups with regard to mean neonatal Hb (17.6g/dl, sd 2.0 vs 17.4g/dl, sd 2.4, p=0.67), mean neonatal total bilirubin (111.8 mmol/l, sd 47.6 vs 123.0mmol/l, sd 35.0, p=0.69) and mean maternal decrease in Hb (1.0g/dl, sd 0.7 vs 1.3g/dl, sd 1.0, p=0.37). All the neonates had birth APGAR of 10 at 5 minutes. The volume of blood remaining in the placenta was significantly higher in the UCM group (29.5ml, sd 20.3 vs 19.5ml, sd 13.1, p=0.03). Conclusions: Neonatal and maternal outcomes are not better with UCM than with DCC during elective CD.

Timing of umbilical cord clamping of term infants.

For at least over 200 years, multiple controversies have arisen around the timing of umbilical cord clamping. In the past decades, early cord clamping (within the first 15 seconds) had markedly prevailed. Only in the 21st century, randomized controlled trials have demonstrated the benefits of delayed cord clamping (at 2-3 minutes). Delayed cord clamping has been practiced in obstetrics based on the recommendations made by scientific societies and in systematic reviews, which have provided solid evidence to support this practice in term infants. This review describes the most relevant factors supporting the use of delayed cord clamping in term infants. It points out the essential role played by physiological mechanisms which, undoubtedly, allow us to understand the benefits of delayed cord clamping and advise us to wait for what nature has established. Other relevant aspects supporting delayed cord clamping are also described here.

Committee Opinion No. 684 Summary: Delayed Umbilical Cord Clamping After Birth.

Delayed umbilical cord clamping appears to be beneficial for term and preterm infants. In term infants, delayed umbilical cord clamping increases hemoglobin levels at birth and improves iron stores in the first several months of life, which may have a favorable effect on developmental outcomes. There is a small increase in jaundice that requires phototherapy in this group of infants. Consequently, health care providers adopting delayed umbilical cord clamping in term infants should ensure that mechanisms are in place to monitor for and treat neonatal jaundice. In preterm infants, delayed umbilical cord clamping is associated with significant neonatal benefits, including improved transitional circulation, better establishment of red blood cell volume, decreased need for blood transfusion, and lower incidence of necrotizing enterocolitis and intraventricular hemorrhage. Delayed umbilical cord clamping was not associated with an increased risk of postpartum hemorrhage or increased blood loss at delivery, nor was it associated with a difference in postpartum hemoglobin levels or the need for blood transfusion. Given the benefits to most newborns and concordant with other professional organizations, the American College of Obstetricians and Gynecologists now recommends a delay in umbilical cord clamping in vigorous term and preterm infants for at least 30-60 seconds after birth. The ability to provide delayed umbilical cord clamping may vary among institutions and settings; decisions in those circumstances are best made by the team caring for the mother-infant dyad.

Committee Opinion No. 684: Delayed Umbilical Cord Clamping After Birth.

Delayed umbilical cord clamping appears to be beneficial for term and preterm infants. In term infants, delayed umbilical cord clamping increases hemoglobin levels at birth and improves iron stores in the first several months of life, which may have a favorable effect on developmental outcomes. There is a small increase in jaundice that requires phototherapy in this group of infants. Consequently, health care providers adopting delayed umbilical cord clamping in term infants should ensure that mechanisms are in place to monitor for and treat neonatal jaundice. In preterm infants, delayed umbilical cord clamping is associated with significant neonatal benefits, including improved transitional circulation, better establishment of red blood cell volume, decreased need for blood transfusion, and lower incidence of necrotizing enterocolitis and intraventricular hemorrhage. Delayed umbilical cord clamping was not associated with an increased risk of postpartum hemorrhage or increased blood loss at delivery, nor was it associated with a difference in postpartum hemoglobin levels or the need for blood transfusion. Given the benefits to most newborns and concordant with other professional organizations, the American College of Obstetricians and Gynecologists now recommends a delay in umbilical cord clamping in vigorous term and preterm infants for at least 30-60 seconds after birth. The ability to provide delayed umbilical cord clamping may vary among institutions and settings; decisions in those circumstances are best made by the team caring for the mother-infant dyad.

Hemoglobina en recién nacidos por parto vaginal según clampaje precoz o tardío del cordón umbilical, a 2700 metros sobre el nivel del mar

Diversos estudios han demostrado que un clampaje tardío del cordón umbilical aumenta los niveles de hemoglobina de los recién nacidos. Objetivos: Evaluar si el clampaje tardío del cordón umbilical en neonatos a término muestra mayores valores de hemoglobina que cuando se realiza clampaje precoz, a 2700 msnm. Diseño: Investigación prospectiva, aleatorizada y doble ciego. Institución: Departamento de GinecoObstetricia, Hospital Regional de Cajamarca, Perú. Participantes: Recién nacidos y sus madres. Métodos: En enero de 2014, a 100 gestantes en trabajo de parto con gestación única, a término y sin otros factores de riesgo, se asignó al azar clampaje tardío (cuando dejó de latir el cordón umbilical 1 a 3 minutos) o clampaje precoz (alrededor de 10 segundos después del parto). Se midió el tiempo desde que aparecieron los hombros del bebé. Se procedió a sacar una muestra de sangre del talón derecho del recién nacido en 2 capilares y a las 6 horas de vida, y se analizó la hemoglobina, el hematocrito y grupo y factor Rh. Principales medidas de resultados: Nivel de hemoglobina. Resultados: Encontramos 91% de gestantes sin anemia y 9% con anemia; el grupo sanguíneo materno predominante fue el O+ en 86%. Se practicó clampaje tardío a 52 recién nacidos y clampaje precoz a 48. El 94% de los recién nacidos pesó entre 2 501 y 3 999 g, con Ápgar &gt;7 en el 100%. El tiempo en que dejó de latir el cordón umbilical fue 2,67+-0,28 minutos. En 100% de los neonatos con clampaje temprano el valor de la hemoglobina fue &lt;15 mg/dL y en el clampaje tardío el 71,1% presentó hemoglobina de 15,1 a 20,1 mg/dL, y 28,9% más de 20,1 mg/dL. No hubo diferencia significativa en los valores de hemoglobina de los recién nacidos sí la madre presentó o no anemia. Conclusiones: El clampaje tardío mostró mejores valores de hemoglobina en los neonatos. El tiempo medio en que dejó de latir el cordón fue 2,67 min y la anemia materna no influyó en la hemoglobina neonatal.

Cochrane in context: Effect of timing of umbilical cord clamping in term infants on maternal and neonatal outcomes.

AbstractCochrane Review: Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes McDonald SJ, Middleton P, Dowswell T, Morris PS. Effect of timing of umbilical cord clamping in term infants on maternal and neonatal outcomes. Cochrane Database of Systematic Reviews 2013, Issue 7. Art. No.: CD004074. DOI: 10.1002/14651858.CD004074.pub3.This companion piece to the review, Effect of timing of umbilical cord clamping in term infants on maternal and neonatal outcomes, contains the following pieces: The abstract of the review A commentary from one or more of the review authors, explaining why the review team felt the review was an important one to produce A review of clinical practice guidelines from the American Academy of Pediatrics and the Canadian Paediatric Society Some other recently published references on this topic

Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes.

Policies for timing of cord clamping vary, with early cord clamping generally carried out in the first 60 seconds after birth, whereas later cord clamping usually involves clamping the umbilical cord more than one minute after the birth or when cord pulsation has ceased. The benefits and potential harms of each policy are debated. To determine the effects of early cord clamping compared with late cord clamping after birth on maternal and neonatal outcomes We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (13 February 2013). Randomised controlled trials comparing early and late cord clamping. Two review authors independently assessed trial eligibility and quality and extracted data. We included 15 trials involving a total of 3911 women and infant pairs. We judged the trials to have an overall moderate risk of bias. MATERNAL OUTCOMES: No studies in this review reported on maternal death or on severe maternal morbidity. There were no significant differences between early versus late cord clamping groups for the primary outcome of severe postpartum haemorrhage (risk ratio (RR) 1.04, 95% confidence interval (CI) 0.65 to 1.65; five trials with data for 2066 women with a late clamping event rate (LCER) of ~3.5%, I(2) 0%) or for postpartum haemorrhage of 500 mL or more (RR 1.17 95% CI 0.94 to 1.44; five trials, 2260 women with a LCER of ~12%, I(2) 0%). There were no significant differences between subgroups depending on the use of uterotonic drugs. Mean blood loss was reported in only two trials with data for 1345 women, with no significant differences seen between groups; or for maternal haemoglobin values (mean difference (MD) -0.12 g/dL; 95% CI -0.30 to 0.06, I(2) 0%) at 24 to 72 hours after the birth in three trials. NEONATAL OUTCOMES: There were no significant differences between early and late clamping for the primary outcome of neonatal mortality (RR 0.37, 95% CI 0.04 to 3.41, two trials, 381 infants with a LCER of ~1%), or for most other neonatal morbidity outcomes, such as Apgar score less than seven at five minutes or admission to the special care nursery or neonatal intensive care unit. Mean birthweight was significantly higher in the late, compared with early, cord clamping (101 g increase 95% CI 45 to 157, random-effects model, 12 trials, 3139 infants, I(2) 62%). Fewer infants in the early cord clamping group required phototherapy for jaundice than in the late cord clamping group (RR 0.62, 95% CI 0.41 to 0.96, data from seven trials, 2324 infants with a LCER of 4.36%, I(2) 0%). Haemoglobin concentration in infants at 24 to 48 hours was significantly lower in the early cord clamping group (MD -1.49 g/dL, 95% CI -1.78 to -1.21; 884 infants, I(2) 59%). This difference in haemoglobin concentration was not seen at subsequent assessments. However, improvement in iron stores appeared to persist, with infants in the early cord clamping over twice as likely to be iron deficient at three to six months compared with infants whose cord clamping was delayed (RR 2.65 95% CI 1.04 to 6.73, five trials, 1152 infants, I(2) 82%). In the only trial to report longer-term neurodevelopmental outcomes so far, no overall differences between early and late clamping were seen for Ages and Stages Questionnaire scores. A more liberal approach to delaying clamping of the umbilical cord in healthy term infants appears to be warranted, particularly in light of growing evidence that delayed cord clamping increases early haemoglobin concentrations and iron stores in infants. Delayed cord clamping is likely to be beneficial as long as access to treatment for jaundice requiring phototherapy is available.

Timing of cord clamping in very preterm infants: more evidence is needed

In December 2012, the American College of Obstetricians and Gynecologists published a Committee Opinion entitled "Timing of umbilical cord clamping after birth." It stated that "evidence exists to support delayed cord clamping in preterm infants, when feasible. The single most important benefit for preterm infants is the possibility for a nearly 50% reduction in IVH." However, the Committee Opinion added that the ideal timing of umbilical cord clamping has yet to be determined and recommended that large clinical trials be conducted in the most preterm infants. Published randomized controlled trials include <200 infants of <30 weeks' gestation, with assessments of neurodevelopmental outcome in less than one-half of the children. This is a major gap in the evidence. Without reliable data from randomized controlled trials that optimally include childhood follow-up evaluations, we will not know whether delayed cord clamping may do more overall harm than good. Ongoing trials of delayed cord clamping plan to report childhood outcomes in >2000 additional very preterm infants. Current recommendations may need to change when these results become available. Greater international collaboration could accelerate resolution of whether this promising intervention will improve disability-free survival in about 1 million infants who will be born very preterm globally each year.

Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes.

Policies for timing of cord clamping vary, with early cord clamping generally carried out in the first 60 seconds after birth, whereas later cord clamping usually involves clamping the umbilical cord more than one minute after the birth or when cord pulsation has ceased. The benefits and potential harms of each policy are debated. To determine the effects of early cord clamping compared with late cord clamping after birth on maternal and neonatal outcomes We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (13 February 2013). Randomised controlled trials comparing early and late cord clamping. Two review authors independently assessed trial eligibility and quality and extracted data. We included 15 trials involving a total of 3911 women and infant pairs. We judged the trials to have an overall moderate risk of bias. Maternal outcomes: No studies in this review reported on maternal death or on severe maternal morbidity. There were no significant differences between early versus late cord clamping groups for the primary outcome of severe postpartum haemorrhage (risk ratio (RR) 1.04, 95% confidence interval (CI) 0.65 to 1.65; five trials with data for 2066 women with a late clamping event rate (LCER) of ~3.5%, I(2) 0%) or for postpartum haemorrhage of 500 mL or more (RR 1.17 95% CI 0.94 to 1.44; five trials, 2260 women with a LCER of ~12%, I(2) 0%). There were no significant differences between subgroups depending on the use of uterotonic drugs. Mean blood loss was reported in only two trials with data for 1345 women, with no significant differences seen between groups; or for maternal haemoglobin values (mean difference (MD) -0.12 g/dL; 95% CI -0.30 to 0.06, I(2) 0%) at 24 to 72 hours after the birth in three trials. Neonatal outcomes: There were no significant differences between early and late clamping for the primary outcome of neonatal mortality (RR 0.37, 95% CI 0.04 to 3.41, two trials, 381 infants with a LCER of ~1%), or for most other neonatal morbidity outcomes, such as Apgar score less than seven at five minutes or admission to the special care nursery or neonatal intensive care unit. Mean birthweight was significantly higher in the late, compared with early, cord clamping (101 g increase 95% CI 45 to 157, random-effects model, 12 trials, 3139 infants, I(2) 62%). Fewer infants in the early cord clamping group required phototherapy for jaundice than in the late cord clamping group (RR 0.62, 95% CI 0.41 to 0.96, data from seven trials, 2324 infants with a LCER of 4.36%, I(2) 0%). Haemoglobin concentration in infants at 24 to 48 hours was significantly lower in the early cord clamping group (MD -1.49 g/dL, 95% CI -1.78 to -1.21; 884 infants, I(2) 59%). This difference in haemoglobin concentration was not seen at subsequent assessments. However, improvement in iron stores appeared to persist, with infants in the early cord clamping over twice as likely to be iron deficient at three to six months compared with infants whose cord clamping was delayed (RR 2.65 95% CI 1.04 to 6.73, five trials, 1152 infants, I(2) 82%). In the only trial to report longer-term neurodevelopmental outcomes so far, no overall differences between early and late clamping were seen for Ages and Stages Questionnaire scores. A more liberal approach to delaying clamping of the umbilical cord in healthy term infants appears to be warranted, particularly in light of growing evidence that delayed cord clamping increases early haemoglobin concentrations and iron stores in infants. Delayed cord clamping is likely to be beneficial as long as access to treatment for jaundice requiring phototherapy is available.

Committee Opinion No. 543

The optimal timing for clamping the umbilical cord after birth has been a subject of controversy and debate. Although many randomized controlled trials in term and preterm infants have evaluated the benefits of delayed umbilical cord clamping versus immediate umbilical cord clamping, the ideal timing for cord clamping has yet to be established. Several systematic reviews have suggested that clamping the umbilical cord in all births should be delayed for at least 30-60 seconds, with the infant maintained at or below the level of the placenta because of the associated neonatal benefits, including increased blood volume, reduced need for blood transfusion, decreased incidence of intracranial hemorrhage in preterm infants, and lower frequency of iron deficiency anemia in term infants. Evidence exists to support delayed umbilical cord clamping in preterm infants, when feasible. The single most important clinical benefit for preterm infants is the possibility for a nearly 50% reduction in intraventricular hemorrhage. However, currently, evidence is insufficient to confirm or refute the potential for benefits from delayed umbilical cord clamping in term infants, especially in settings with rich resources.

21 Delayed Cord Clamping In Preterm Infants (< 32 Weeks of Gestation): Current Clinical Practice in the United Kingdom

BackgroundResuscitation guidelines recommend delayed cord clamping in term infants and this practice is being widely adopted in the UK. But there are no clear recommendations for early or delayed cord...

Cord clamping guidance

British Journal of Midwifery • September 2012 • Vol 20, No 9 New guidance by the Royal College of Midwives (RCM) on the timing of cord clamping is expected to be unveiled at the RCM conference in November. The new guidance will recommend delaying clamping the cord until after it has stopped pulsating—sometime between 3 and 5 minutes. Delaying cord clamping is thought to protect babies against iron deficiency and anaemia, and allows vital stem cells to be transferred. Currently, midwives are advised to clamp the cord within 30 seconds of birth (National Institute for Health and Clinical Excellence (NICE), 2007). It was previously thought that cutting the cord within 30 seconds protects babies from exposure to hormones given to speed up labour and deliver the placenta and could also prevent jaundice. The change in guidance follows a growing number of studies highlighting the benefits of delayed cord clamping. For example, in a Swedish study that looked at the outcomes of 400 babies born after a low-risk pregnancy, where some had their umbilical cords clamped after at least 3 minutes and others were clamped in less than 10 seconds after delivery, Andersson et al (2011) found that babies with delayed clamping had better iron levels at 4 months of age and were far less likely to suffer newborn anaemia. Hutton and Hassan (2007) compared the potential benefits and harms of late vs early cord clamping in term infants. They found that delaying cord clamping by 2 minutes could half the risk of anaemia. The benefits of delayed cord clamping have been known for sometime—Hutton and Hassan’s meta-analysis was over 5 years ago. The World Health Organization (WHO) dropped early clamping from its guidelines some years ago as anaemia is a big problem in the developing world (WHO, 2009). The Royal College of Obstetricians and Gynaecologists (RCOG) also updated its guidelines in 2009 to state that: ‘the cord should not be clamped earlier than is necessary, based on clinical assessment of the situation. Evidence suggests that delayed cord clamping (more than 30 seconds) may benefit the neonate in reducing anaemia, and particularly the preterm neonate by allowing time for transfusion of placental blood to the newborn infant,which can provide an additional 30% blood volume. In the preterm infant (less than 37+0 weeks of gestation), this may reduce the need for transfusion and reduce intraventricular haemorrhage. Delayed cord clamping does not appear to increase the risk of postpartum haemorrhage’ (RCOG, 2009). The change in guidelines is definitely welcome, but the question has to be asked why has it taken so long for us to catch up? BJM

Research Summaries for Normal Birth

In this column, the author presents summaries of four research studies that further support the benefits of normal birth. The topics of the studies address cord clamping of term infants, the association of multiple cesareans and placental abnormalities, induction of labor at 41 weeks, and the World Health Organization's recently released pediatric growth charts.