Factors associated with timing of umbilical cord clamping in tertiary hospital of Nepal

Nelin, Viktoria; Kc, Ashish; Andersson, Ola; Rana, Nisha

doi:10.1186/s13104-018-3198-8

Cited by 15 publications

(23 citation statements)

References 14 publications

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“…The cutoff point for ECC was based on the observational study done in the same hospital that showed an average cord clamping time at 61 s [19]. The study site, Paropakar Maternity and Women’s Hospital, is a publicly funded hospital in Kathmandu, Nepal.…”

Section: Methodsmentioning

confidence: 99%

Effect of Delayed Cord Clamping of Term Babies on Neurodevelopment at 12 Months: A Randomized Controlled Trial

Rana

Subedi³

et al. 2018

Neonatology

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Background: Delayed cord clamping (DCC) is associated with an improved iron status at 8 months, a reduction of anemia at 12 months, and an improved development at 4 years. Assessment of the development after DCC has not been performed earlier in a setting with a high prevalence of iron deficiency. Objective: The aim of this paper was to investigate the effects of DCC compared to early cord clamping (ECC) on the development evaluated with the Ages and Stages Questionnaire (ASQ) at 12 months of age. Method: We conducted a randomized controlled trial investigating the effect of DCC (≥180 s) versus ECC (≤60 s) in 540 full-term deliveries. Twelve months after delivery, the parents reported their infant’s development by ASQ. Infants having a score < 1 standard deviation (SD) under the mean score were considered “at risk” of affected neurodevelopment. Results: At 12 months of age, 332 (61.5%) infants were assessed. Fewer children in the DCC group were “at risk” of having affected neurodevelopment measured by the ASQ total score, 21 (7.8%) versus 49 (18.1%) in the ECC group. The relative risk was 0.43 (0.26–0.71). Infants in the DCC group had higher mean total scores (SD), 290.4 (10.4) versus 287.2 (10.1), p = 0.01. Significantly fewer infants in the delayed group were “at risk” and had higher scores in the domains “communication”, “gross motor”, and “personal-social”. Conclusions: DCC after 3 min was associated with an improvement of the overall neurodevelopment assessed at 12 months of age as compared to infants in the group with cord clamping within 1 min.

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Section: Methodsmentioning

confidence: 99%

Effect of Delayed Cord Clamping of Term Babies on Neurodevelopment at 12 Months: A Randomized Controlled Trial

Rana

Subedi³

et al. 2018

Neonatology

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“…These findings contradict advice of the Committee Opinion of The American College of Obstetricians and Gynaecologists, which has stated that delayed cord clamping in term infants increases the incidence of jaundice and the risk of associated complications. The Committee recommends that mechanisms to monitor and treat neonatal jaundice are in place before adopting the practice of delayed cord clamping .…”

Section: Discussionmentioning

confidence: 99%

“…The mothers were randomised during the second stage of delivery to either early cord clamping within 60 seconds (n = 270) or delayed cord clamping after 180 seconds (n = 270). The cut‐off for early cord clamping was based on an observational study held in the same hospital, which showed a mean and standard deviation cord clamping time of 61 ± 33 seconds . The study was approved by the institutional review board of the hospital and the ethical review board of Nepal Health Research Council (Ref 76/2014).…”

Section: Methodsmentioning

confidence: 99%

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Delayed cord clamping was not associated with an increased risk of hyperbilirubinaemia on the day of birth or jaundice in the first 4 weeks

Rana

Ranneberg

et al. 2019

Acta Paediatrica

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Aim Our aim was to investigate the effects of timing of cord clamping on the risk of hyperbilirubinaemia. Methods We recruited 540 normal vaginal deliveries at the Paropakar Maternity and Women’s Hospital in Kathmandu, Nepal, from October 2 to November 21, 2014. They were randomised into two groups: 257/270 were cord clamped within 60 seconds and 209/270 after 180 seconds. Transcutaneous bilirubin was measured at discharge and 24 hours. At 4 weeks, 506 mothers were successfully contacted by phone, and the health status of the baby and their history of jaundice and treatment was recorded. Results Based on transcutaneous bilirubin at discharge, 22/261 (8.4%) in the early group and 25/263 (9.5%) in the delayed group (P = 0.76) were at high risk of subsequent hyperbilirubinemia. At the 4‐week follow‐up, jaundice was reported in 13/253 (5.1%) in the early and 17/253 (6.7%) in the delayed group (P = 0.57) and 3/253 (1.2 %) of the early and 1/253 (0.4%) of the delayed group (P = 0.62) received treatment. All analyses were based on intention‐to‐treat. Conclusion Delayed cord clamping was not associated with an increased risk of hyperbilirubinaemia during the first day of life or risk of jaundice within 4 weeks compared with the early group.

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“…[20][21][22][23][24][25][26][27] This review aimed to answer the questions: (a) What strategies are used to implement delayed cord clamping or cord milking in different settings around the world? [20][21][22][23][24][25][26][27] This review aimed to answer the questions: (a) What strategies are used to implement delayed cord clamping or cord milking in different settings around the world?…”

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confidence: 99%

Strategies for implementing placental transfusion at birth: A systematic review

Anton

Jordan

Rabe

2018

Birth

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Background Enhanced placental transfusion reduces adverse neonatal outcomes, including death. Despite being endorsed by the World Health Organization in 2012, the method has not been adopted widely in practice. Methods We performed a systematic literature search and included quality improvement projects on placental transfusion at birth and studies on barriers to implementation. We extracted information on population, methods of implementation, obstacles to implementation, and strategies to overcome them. Results We screened 99 studies out of which 18 were included in the review. The preferred methods of implementation were protocol development (86% of studies) reinforced by targeted education (64% of studies) and multidisciplinary team involvement (43% of studies). Barriers to implementation were mentioned in 12 studies and divided into four categories: general factors such as lack of staff awareness (5 studies) and professional resistance to change (5 studies); obstetrician‐specific concerns, including the impact during cesarean (3 studies) and the risk of postpartum hemorrhage (3 studies); pediatrician‐specific concerns, including the need for resuscitation (5 studies), risk of jaundice (3 studies), and polycythemia (2 studies); and logistical difficulties. The main strategies to facilitate placental transfusion at birth included effective multidisciplinary team collaboration, protocol development, targeted education, and constructive feedback sessions. Conclusions Placental transfusion implementation requires a multidisciplinary approach, with obstetricians, midwives, nurses, and pediatricians central to adoption of the practice. Understanding the obstacles to implementation informs strategies to increase placental transfusion adoption of practice worldwide. We suggest a stepwise approach to implementation and enhancement of placental transfusion into practice.

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Factors associated with timing of umbilical cord clamping in tertiary hospital of Nepal

Cited by 15 publications

References 14 publications

Effect of Delayed Cord Clamping of Term Babies on Neurodevelopment at 12 Months: A Randomized Controlled Trial

Effect of Delayed Cord Clamping of Term Babies on Neurodevelopment at 12 Months: A Randomized Controlled Trial

Delayed cord clamping was not associated with an increased risk of hyperbilirubinaemia on the day of birth or jaundice in the first 4 weeks

Strategies for implementing placental transfusion at birth: A systematic review

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