A Survey on Current Practices of Umbilical Cord Clamping in Malaysia

Abstract

BackgroundDelayed cord clamping (DCC) has been demonstrated to have significant benefits in reducing the incidence of intraventricular hemorrhage, blood transfusion and neonatal mortality in preterm neonates and improving hemodynamic and long-term neurodevelopment among term infants. There is no clear guideline on umbilical cord clamping (UCC) practices in Malaysia.ObjectiveThe aim of this survey was to assess the knowledge and practice of DCC among obstetric doctors and midwives in Malaysia, and pediatric colleagues who witness the delivery.MethodThis is a cross-sectional survey conducted in childbirth facilities in Malaysia from October 2020 to January 2021. A convenient snowball sampling was adopted. A validated questionnaire was disseminated to practicing obstetric and pediatric doctors and midwives electronically via email and WhatsApp using Google Form. The data were analyzed using descriptive and analytical statistics.ResultsA total of 327 respondents completed the questionnaires, comprising 206 obstetric doctors, 72 pediatric doctors and 49 midwives. The majority of respondents were specialists or higher in rank (53.2%). Only 29% reported the existence of guidelines on UCC in their place of work. Midwives (P = 0.003) and staff of lower ranks and level of education (P < 0.001) appeared to be more aware of the existence of a UCC guideline. Most respondents had positive knowledge of DCC for both term and preterm neonates. A large proportion (82%) of respondents agreed that DCC helped increase neonatal iron stores, and was good for both preterm (70.7%) and term (76.2%) neonates not requiring positive pressure ventilation. Doctors, specialists, those who are 40 years old and above, and those who have been in service for at least 10 years were found to have better knowledge regarding DCC (P < 0.05).ConclusionThe awareness and practice of obstetric, pediatric and midwifery staff of guidelines on UCC were less than satisfactory. Even though most respondents have good knowledge and positive perception regarding benefits of DCC, these were not translated into their routine practice. Hence, a national guideline emphasizing the benefits of DCC should be made available in all childbirth facilities.

Barriers and facilitators in implementing early essential newborn care of well‐born babies in low‐ and middle‐income countries: A mixed‐method systematic review

“…2023; Pong et al. 2022). We defined barriers and facilitators as modifiable factors that hindered or supported the implementation of EENC.…”

“…The interventions of interest were those covering at least one of the four key practices of EENC: immediate and thorough drying, immediate skin-to-skin contact, delayed cord clamping and early initiation of breastfeeding (Mannava & Sobel, 2019). These procedures have been demonstrated to increase the rate of exclusive breastfeeding and improve haemodynamics and long-term neurodevelopment (Aboagye et al 2023;Pong et al 2022). We defined barriers and facilitators as modifiable factors that hindered or supported the implementation of EENC.…”

Apgar Score and the Amount of Blood of Mother in Labour in Delayed Cord Clamping Period

“…Polycythemia is defined as an Ht level greater than 65% and occurs in about 2% -5% of full-term infants. Delayed clamping can increase the baby's hematocrit value because there is additional blood volume (Pong et al, 2022). The main concern with Polycythemia is related to blood hyperviscosity, which can increase bilirubin levels, but good blood flow allows the liver to process bilirubin more efficiently (Purisch et al, 2019).…”