Early Versus Delayed Umbilical Cord Clamping on Physiologic Anemia of the Term Newborn Infant

Abstract

AIM:Our study aims to make a comparison between the effects of milking of umbilical cord versus delayed cord clamping on Hemoglobin level at 6 weeks from delivery among term neonates and which method is more beneficial for them.DESIGN:It was a randomised control study. Participants were randomised into 2 groups; Group 1: 125 women were assigned to delay cord clamping; Group 2: 125 women were assigned to milking of the umbilical cord 5 times before cutting. Student t-test was used to compare between the two groups for quantitative data, for qualitative data chi-square test and the Correlation coefficient was done to test the association between variables.SETTING:This study was at El-Galaa Teaching Hospital, labour suite. Cairo, Egypt.PARTICIPANTS:A group of 250 pregnant women starting from ≥ 37 weeks’ gestational age.INTERVENTION:In this study, we searched if the mechanism of milking or delayed cord clamping could give some of the positive benefits for neonates or not.RESULTS:In this study, we found that milking of the umbilical cord five times as in group 1 was associated with higher hemoglobin levels at 6 weeks after birth, at physiological anemia of the fetus and significant but clinically there was no difference between the two groups (10.4 ± 0.5 and 10.6 ± 0.5 respectively, P < 0.001). Also, there was a positive correlation between haemoglobin of the mother and the newborn during the first day and after 6 weeks with r = 0.349 and 0.283 respectively and a P value < 0.001. Furthermore, there was a positive correlation between the haemoglobin of the fetus after the first day and fetus at 6 weeks with r = 0.534 and a P value < 0.001. For most other outcomes (including APGAR score, positive pressure ventilation, poor neonatal outcomes such as respiratory distress syndrome there were no significant differences between the two groups. Our study may recommend the use of umbilical cord milking in term babies when delayed cord clamping is unavailable.CONCLUSION:Umbilical cord blood milking after its clamping improves some important haematological parameters for newborns, especially in countries with high incidence of anaemia in newborns and children.

Effects of cord milking in late preterm infants and full‐term infants: A systematic review and meta‐analysis

“…Hemoglobin at 24 hours of birth When grouping 5 newborn studies ≥34 GA, [26][27][28]30,34 no significant differences in initial hemoglobin values between the intervention and the control groups were observed (Figure 2A,B). In another study, 27 newborns between 34 and 37 GA proved to have increased hemoglobin levels in the intervention group (PWMD 1.60 g/L [0.96-2.23]) relative to the control group ( Table 2 and Table S2).…”

“…The sample included 1845 newborns with GA between 34 6 and 41 6/7 weeks. The selected studies were conducted in the United States, 26 India, [27][28][29][30][31][32] Egypt, 33,34 and Italy. 35 The sample size of the studies ranged from 24 to 300 newborns.…”

“…35 The sample size of the studies ranged from 24 to 300 newborns. UCM was compared with DCC in six RCTs 28,29,[31][32][33][34] and ICC in four RCTs. 26,27,30,35 One RCT 28 included DCC as control and DCC with milking the cut cord (DCM).…”

“…Six studies [27][28][29]31,33,34 evaluated hemoglobin levels at 6 weeks after birth in newborns with GA ≥ 34, and no significant differences were found between the intervention and the control group. However, in four studies on 885 ≥ 37 GA newborns, 28,29,33,34 a significant decrease in hemoglobin levels at 6 weeks from birth was observed in the intervention group as compared to the control group (PWDM-0.16 g/L [−0.26 to −0.06]) ( Figure 2C,D, Table 2 and Table S2).…”

“…In the subanalysis by control group, when comparing the intervention group with the ICC group, only one study 27 showed an increase in hemoglobin levels at 6 weeks (PWDM 1.10 g/L [0.73 to 1.47]). However, in five studies evaluating UCM versus DCC, 28,29,31,33,34 hemoglobin levels at 6 weeks of birth were lower in the intervention group, as compared to the control group (PWDM-0.16 g/L [−0.26 to-0.06]) ( Table 2 and Table S2).…”