A randomized clinical trial comparing immediate versus delayed clamping of the umbilical cord in preterm infants: short‐term clinical and laboratory endpoints

Strauss, Ronald G.; Mock, Donald M.; Johnson, Karen; Cress, Gretchen A.; Burmeister, Leon F.; Zimmerman, M. Bridget; Bell, Edward F.; Rijhsinghani, Asha

doi:10.1111/j.1537-2995.2007.01589.x

Cited by 124 publications

(88 citation statements)

References 21 publications

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“…[25][26][27][28][29][30][31][32][33][34][35] For the critical outcome of severe IVH, we identified very-low-quality evidence (downgraded for imprecision and very high risk of bias) from 5 randomized clinical trials enrolling 265 patients showing no benefit to delayed cord clamping (OR, 0.85; 95% CI, 0.20-3.69). 26,27,31,32 For the critical outcome of periventricular hemorrhage (PVH)/IVH, we identified very-low-quality evidence (downgraded for imprecision and very high risk of bias) from 9 randomized clinical trials enrolling 499 patients showing benefit of delayed cord clamping (OR, 0.49; 95% CI, 0.29-0.82).…”

Section: Consensus On Sciencementioning

confidence: 99%

Part 7: Neonatal Resuscitation

Perlman¹,

Wyllie²,

Kattwinkel³

et al. 2015

Pediatrics

234

291

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Section: Consensus On Sciencementioning

confidence: 99%

Part 7: Neonatal Resuscitation

Perlman¹,

Wyllie²,

Kattwinkel³

et al. 2015

Pediatrics

234

291

View full text Add to dashboard Cite

“…In a study on infants with gestational age less than 36 weeks in two groups of immediate and delayed clamping, Strauss et al (2008) reported a significant increase in circulating RBC volume/mass (P = 0.04) and weekly hematocrit (P < 0.005). In that study, the need for mechanical ventilation did not differ between the two groups, and the need for phototherapy was higher in the delayed group (7). No case of seizure was observed in the delayed clamping group.…”

Section: Discussionmentioning

confidence: 68%

Effects of Delayed Cord Clamping on Intraventricular Hemorrhage in Preterm Infants

et al. 2017

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Background: One of the benefits of delayed cord clamping is a reduction in the rate of intraventricular hemorrhage. The findings in this regard are controversial and some negative effects of the procedure have been reported. Objectives: The purpose of this study was to investigate the effects of delayed cord clamping on intraventricular hemorrhage in preterm infants. Methods: This clinical trial was carried out on 70 preterm neonates delivered via cesarean section. Their gestational age was less than 32 weeks and the birth weight less than 1500 grams. Neonates were randomly assigned to two groups of early cord clamping (less than 10 seconds) or delayed clamping of the umbilical cord (30 -45 seconds after birth). 3 to 7 days after birth, presence of Intraventricular hemorrhage (IVH) in both groups was checked by ultrasonography (Mindray machine, model m7) and. Rate and severity of IVH was compared between the two groups. Results: There was no significant difference in mean gestational age, birth weight, gender distribution and medications in both groups of delayed cord clamping and early clamping of the umbilical cord. The incidence of seizures in the early clamping was 8.6% and in the delayed clamping zero (P = 0.239). The incidence rate of IVH and periventricular leukomalacia (PVL) was 11.43% and 5.7%, respectively in the early clamping, while this rate was zero in the delayed clamping group. This difference was not statistically significant in both indicators (P = 0.12 and P = 0.493, respectively). Conclusions:The results showed that intraventricular hemorrhage in premature neonates with delayed clamping was less prevalent than those with early clamping, and may be used as a reliable method.

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“…29 Preterm infants (30-36 weeks' gestation at birth) randomized to delayed cord clamping (at 1 minute of age) had larger circulating red blood cell (RBC) volume, no difference in hematocrit at birth, but higher hematocrit at 7, 14, 21, and 28 days of age compared with preterm infants randomized to immediate cord clamping within 5 seconds of birth. 30,31 There was no increase in polycythemia or jaundice in the delayed cord clamping groups. 31 Another randomized controlled trial found that preterm infants assigned to delayed cord clamping (30-90 seconds after birth) had significantly higher blood volumes regardless of mode of delivery (cesarean section or vaginal delivery) compared with infants who had immediate cord clamping.…”

Section: Preterm Infantsmentioning

confidence: 98%

“…30,31 There was no increase in polycythemia or jaundice in the delayed cord clamping groups. 31 Another randomized controlled trial found that preterm infants assigned to delayed cord clamping (30-90 seconds after birth) had significantly higher blood volumes regardless of mode of delivery (cesarean section or vaginal delivery) compared with infants who had immediate cord clamping. 32 Kinmond and colleagues reported that preterm infants randomized to "regulated" cord clamping (delay for 30 seconds with the infant held below the introitus) had higher hematocrits without polycythemia, a lower requirement for blood transfusion, and spent less time on supplemental oxygen compared with preterm infants assigned to "random" cord clamping (within 10 seconds of birth and not held below the introitus).…”

Section: Preterm Infantsmentioning

confidence: 98%

“…Higher blood pressure in first 24 hours 20 Higher hemoglobin at birth, 10 weeks of age 29,41 Higher blood volume in first 12 hours 21 Larger circulating RBC volume at birth 31 Higher urine output in first 12 hours 21 Higher hematocrit at 7 to 28 days of age 31,32 Higher hemoglobin at 4 months of age 22 Higher blood volume at birth 33 Lower incidence of iron deficiency 22 Higher hematocrit without polycythemia at birth 34 Slight increase in need for phototherapy 25 Less need for blood transfusion 34,35 No increase in the need to treat polycythemia 24,25 Less time on supplemental oxygen 34 No increase in maternal morbidity 25,27 Higher initial mean blood pressure 36 Lower incidence of hypoglycemia 36 Lower incidence of late-onset sepsis 37 Lower incidence of IVH 37,38 Improved PDI on BSID in male preterm infants 39 Abbreviations: BSID, Bayley scales of infant development; IVH, intraventricular hemorrhage; PDI, psychomotor developmental index; RBC, red blood cells.…”

Section: Term Newborns Preterm Newbornsmentioning

confidence: 99%

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2017

Amer J Perinatol

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Management of the third stage of labor includes clamping of the umbilical cord after delivery of the infant, use of uterotonic medications (e.g., Pitocin) and controlled traction applied to the umbilical cord, and possibly uterine massage. This review will focus on the first step in the process, that is, cord clamping.It is often useful to be familiar with the historical practice of medicine as it can influence decisions and evaluation of our current practice. Dr. A.C. Beck wrote in 1941, "Often the cord is clamped at once…this practice is reprehensible since it deprives the immature infant of considerable blood, which it otherwise might take up from the placental circulation… Blood in the umbilical cord should be stripped toward the fetus before the umbilical cord is ligated." 1 The practice of immediate cord clamping after delivery of the newborn infant has recently been challenged by the American College of Obstetrics and Gynecology. The Committee on obstetric practice stated that the evidence now supports the routine delay in cord clamping for at least 30 to 60 seconds for all vigorous term and preterm neonates. 2 In addition, the seventh edition of the Textbook on Neonatal Resuscitation now recommends this practice. 3The purpose of this review is to present the evidence in support of delayed clamping of the umbilical cord. First, we will discuss the effects of delayed cord clamping or cord milking on the transitional physiology of neonates. Then, we will review the effects of delayed cord clamping on neonatal outcomes. Delayed Cord Clamping and Transitional PhysiologyOne needs to understand the physiology of cardiovascular and respiratory transition as a foundation for understanding the role of placental transfusion that results from delayed cord clamping. There are several aspects of transitional physiology to be considered including effects of lung expansion, changes in the distribution of cardiac output, and blood volume shifts that could benefit from placental transfusion and the possible benefits of the transfusion of stem cells into the newborn.The fetal circulation allows for only 7 to 8% of cardiac output into the lungs. 4,5 Over 90% of cardiac output supplies the systemic circulation, of which 35% comes from left ventricular output and the remainder through the fetal shunt supplied by the patent ductus arteriosus (PDA) 6 as shown AbstractThis review presents the effects of delayed umbilical cord clamping on neonatal transitional physiology. The effects of delayed cord clamping on short-and long-term neonatal outcomes are then discussed. There is ample evidence over the last 50 years that delayed cord clamping in preterm infants is beneficial for both short-term and long-term outcomes. Providing ventilation in the initial steps of neonatal resuscitation prior to clamping of the umbilical cord has a physiologic basis and results in better outcomes for newborns. The challenge now is to design equipment and strategies that can allow initial resuscitation very close to the mother while the umbilical cor...

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A randomized clinical trial comparing immediate versus delayed clamping of the umbilical cord in preterm infants: short‐term clinical and laboratory endpoints

Cited by 124 publications

References 21 publications

Part 7: Neonatal Resuscitation

Part 7: Neonatal Resuscitation

Effects of Delayed Cord Clamping on Intraventricular Hemorrhage in Preterm Infants

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