Delayed umbilical cord clamping in preterm infants: A feasibility study

McDonnell, M; Dj, Henderson-Smart

doi:10.1111/j.1440-1754.1997.tb01606.x

Cited by 108 publications

(88 citation statements)

References 9 publications

(3 reference statements)

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“…This may deprive neonates of significant blood volume and can cause neonatal short-term and long-term potential problems such as respiratory distress, anemia and cerebral pulsy and mental retardation. 2,3 Benefits associated with delayed clamping include better cardiopulmonary adaptation, prevention of respiratory distress, prevention of anemia in infancy and increased duration of early breastfeeding. [4][5][6] The concerns regarding delayed cord clamping include the possibility of precipitating polycythemia, hyperviscosity, hyperbilirubinemia and transient tachypnea of the newborn.…”

Section: Introductionmentioning

confidence: 99%

The effect of early and late umbilical cord clamping on neonatal hematocrit

Jahazi

Kordi²,

Mirbehbahani

et al. 2008

J Perinatol

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Objective: To compare the effect of early and late cord clamping (LCC) on neonatal hematocrit at 2 and 18 h of life.Study Design: In this double-blind randomized trial, 64 healthy fullterm vaginally born neonates were randomly allocated to either early (30 s) or late (3 min) umbilical cord clamping. During the interval between delivery and cord clamping, the attendant held the neonate supine at the level of the introitus. Neonatal venous hematocrit was measured at 2 and 18 h of life.Result: Neonatal hematocrit at 2 h of life (61±4.9 vs 61.6±4.5%) and 18 h of life (56.9 ± 4.1 vs 56.2 ± 3.9%) was not significantly different between the two groups. This was also true for neonatal polycythemia (20 vs 23.5%). In the LCC group, placental residual blood volume (PRBV) was 39.5% lower and estimated neonatal blood volume (ENBV) was 7.1% higher than that in the early cord clamping (ECC) group (P<0.001).Conclusion: Late cord clamping does not lead to a significant difference in the hematocrit level of the neonate or neonatal polycythemia, but is associated with a significant increase in ENBV and a significant decrease in PRBV. Further trials should examine the effect of delaying cord clamping for a longer period of time or changing the position that the neonate is held in to determine whether these variations result in more clinically significant results.

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Section: Introductionmentioning

confidence: 99%

The effect of early and late umbilical cord clamping on neonatal hematocrit

Jahazi

Kordi²,

Mirbehbahani

et al. 2008

J Perinatol

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“…The trial in which infants were not lowered failed to show placental transfusion. 8 In the trial with a clamping delay of 1-2 minutes the infants were also not lowered, but the longer delay was sufficient for placental transfusion. 24 …”

Section: >10 CM Abovementioning

confidence: 99%

“…6 The haematological effects of delayed cord clamping in preterm infants were studied in four randomised controlled trials from industrialised countries. [7][8][9][10] The observation period lasted four to six weeks and comprised the time the infants were admitted to the neonatal intensive care unit. Many of these infants born before 30 weeks of gestation would not have…”

Section: Is Delayed Cord Clamping Associated With Improved Haematologmentioning

confidence: 99%

A Practical Approach to Timing Cord Clamping In Resource Poor Settings

&NA;

2007

Obstetric Anesthesia Digest

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There is little agreement among doctors and midwives about the optimal time to clamp the umbilical cord after birth. The most important points of difference relate to maternal and infant safety. Many healthcare workers worldwide tend to clamp the cord and pass the baby off as quickly as possible. Infants in resource poor settings are the main victims of immediate clamping, as this prevents a cost-free means of boosting their small iron stores.Infant anaemia is common in poor communities, especially where malaria is endemic. In sub-Saharan Africa more than 75% of infants are anaemic before 6 months of age. w1-w3 Infant anaemia is associated with increased mortality w4 w5 and with impaired mental and motor development. w6 Its prevention is of critical importance, and delaying clamping of the umbilical cord could be an effective strategy to reduce anaemia and improve child survival.We propose a practice guideline on cord clamping for resource poor countries for singleton vaginal deliveries, based on published systematic reviews, randomised controlled trials, and biological evidence. Taking account of the safety of mothers and infants, we provide evidence about inclusion and exclusion criteria for delayed cord clamping, optimal timing of clamping, infant position during placental-fetal transfusion, and potential side effects. We present the evidence as a series of structured clinical questions, which identify the population concerned (mothers and infants from resource poor countries), the options being compared (mostly delayed versus immediate cord clamping), and the outcome measures used to measure effectiveness and safety of delayed cord clamping. We also present a practical and simple flow chart for quick reference. Clinical questionsIs delayed cord clamping associated with improved haematological status in infancy? Four randomised controlled trials, all from developing countries, evaluated haemoglobin concentrations in term infants 2-4 months after birth. 2-5 Meta-analysis showed that haemoglobin concentrations were significantly higher after delayed cord clamping (317 infants, weighted mean difference 4.9 g/l (95% confidence interval 2.6 to 7.2 g/l)). The proportion of infants with anaemia was lower with delayed cord clamping (three trials, 127 infants, relative risk 0.53 (95% confidence interval 0.40 to 0.69)). 2 3 5 A large randomised controlled trial from Mexico showed a beneficial effect of delayed cord clamping on infant iron status could be measured six months after birth, although haemoglobin levels were no longer different. 6 The haematological effects of delayed cord clamping in preterm infants were studied in four randomised controlled trials from industrialised countries. 7-10 The observation period lasted four to six weeks and comprised the time the infants were admitted to the neonatal intensive care unit. Many of these infants born before 30 weeks of gestation would not have Summary pointsThere is little agreement about the optimal time to clamp the umbilical cord after birth Delaying clamping of ...

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“…2 The lack of benefit could reflect the lack of adequate placental transfusion during DCC for infants delivered by cesarean delivery (CD). [3][4][5] Three trials of DCC that stratified by mode of delivery found no difference in hematocrit levels or tagged red blood cells in infants delivered by CD. [3][4][5] The ACOG statement acknowledges that there are limited data indicating whether DCC performed during CD can improve placental transfusion.…”

Section: What This Study Addsmentioning

confidence: 99%

“…[3][4][5] Three trials of DCC that stratified by mode of delivery found no difference in hematocrit levels or tagged red blood cells in infants delivered by CD. [3][4][5] The ACOG statement acknowledges that there are limited data indicating whether DCC performed during CD can improve placental transfusion. 1 An alternative to DCC is umbilical cord milking (UCM), or stripping, in which the unclamped umbilical cord is grasped and blood is pushed toward the infant several times before it is clamped to autoinfuse blood into the preterm neonate.…”

Section: What This Study Addsmentioning

confidence: 99%

Umbilical Cord Milking Versus Delayed Cord Clamping in Preterm Infants

Katheria¹,

Truong

Cousins

et al. 2015

Obstetrical &Amp; Gynecological Survey

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BACKGROUND AND OBJECTIVE: Delayed cord clamping (DCC) is recommended for premature infants to improve blood volume. Most preterm infants are born by cesarean delivery (CD), and placental transfusion may be less effective than in vaginal delivery (VD). We sought to determine whether infants ,32 weeks born by CD who undergo umbilical cord milking (UCM) have higher measures of systemic blood flow than infants who undergo DCC.

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Delayed umbilical cord clamping in preterm infants: A feasibility study

Cited by 108 publications

References 9 publications

The effect of early and late umbilical cord clamping on neonatal hematocrit

The effect of early and late umbilical cord clamping on neonatal hematocrit

A Practical Approach to Timing Cord Clamping In Resource Poor Settings

Umbilical Cord Milking Versus Delayed Cord Clamping in Preterm Infants

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