Delaying UmbilicalCord Clamping Benefits Newborns Later

Medscape Madical News

Diedtra Henderson / Jul 11, 2013

Pausing 1 to 3 minutes after birth before clamping the umbilical cord halps full-term newborns in the near-term by boosting indicators of healthy blood levels and halving the risk for deficiency up to 6 months later without increasing teh chance of maternal hemorrhaging acoording to a meta-analysis.

Susan J. McDonald, PhD, from the Midwifery Professorial Unit at La Trobe University/Mercy Hospital for Women in Melbourne, Australia, and colleagues reported the results of their systematic review of data from 15 trials in an article published online July 11 in the Cochrane Library.

The research team scoured the Cochrane Pregnancy and Childbirth Group's Trials Register, excluding 37 trials and including 15 randomized trials involving 3911 women and their newborns to determine the pluses and minuses of the timing of umbilical cord clamping for mothers and newborns.The time at which umbilical cords are clamped varies in high-income countries, with active management of the "third stage of labor" sometimes timed to coincide with the crowning of the infant's head, when the anterior shoulder emerges, or after the newborn's birth, according to Dr. McDonald and colleagues. With "early" clamping, 1 clamp is placed near the infant's navel and a second clamp is positioned farther up the umbilical cord; the cord is snipped between the 2 clamps roughly 1 minute after birth. With "late" clamping, the cord is cut roughly 3 minutes after birth, allowing for up to 30% more fetal blood and 60% more red blood cells to be transferred to the infant, the researchers write.

"There were significantly lower infant haemoglobin concentrations at birth for babies in the...early clamping group compared with those in the late clamping group ([mean difference] -2.17 g/dL 95% [confidence interval (CI)] -4.06 to -0.28; random-effects model)," Dr. McDonald and coauthors write.

"Infants in the late clamping group were significantly less likely to have iron deficiency (average [relative risk] 2.65 95% CI 1.04 to 6.73; with a [late clamping event rate] ranging from 0.5% to 70%, I² 82%)," the research team continued.

The authors found no significant difference in the risk for sever postpartum hemorrhaging for mathers (risk ratio, 1.04; 95% CI, 0.65 - 1.65).

Deleyed cord clamping did sligtly increase the risk for jaudice however. "The benefits of deleyed cord clamping need to be weighed against small additional risk of jaudice in newborns." said coauthor Philippa Middleton, form the Autralian Research Center for Health of Women and Babies. Robinson institute, Univeersity of Adelaide, in a news release. "Later cord clamping to increaseiron stores might be particularly beneficial in settings where severre anaemia is common."

"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 may be of benefit in the longer term in promoting better iron stores in infants, as long as access to treatment for jaundice requiring phototherapy is easily accessible," the authors conclude.

Support for the study was provided by the University of Adelaide, the Department of Health and Ageing, the National Institute for Health Research, and the National Health and Medical Research Council. One study author disclosed receiving financial support from the National Institute for Health Research National Health Service Cochrane Collaboration Programme grant scheme. The remaining authors have disclosed no relevant financial relationships.

Cochrane Library. Published online July 11, 2013.