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

Abstract

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.

Evaluation of Introduction of a Delayed Cord Clamping Protocol for Premature Neonates in a High-Volume Maternity Center

“…18,19 Similar to prior work, we found delayed cord clamping is associated with a higher birth hematocrit and reduced need for red blood cell transfusions in the first week of life compared to neonates born prior to the initiation of the protocol. Furthermore, we identified that delayed cord clamping is associated with a decrease in the total number of red blood cell transfusions required over the course of a neonate’s hospitalization.…”

“…Importantly, our data suggest benefits and lack of adverse outcomes associated with delayed cord clamping in a non-trial setting similar to those in a trial setting. 7,8,18,19 Furthermore, our study suggests delayed cord clamping was not associated with inability to collect cord blood gases, as cord blood gases were still recorded for more than 70% of delayed cord clamping patients.…”

Bridging the Gap between Evidence and Practice: A Systematic Review—When Is the Best Time to Clamp the Infant’s Umbilical Cord in Term Low-Risk Women?

“…The authors noted that placental blood is rapidly transferred into the neonate following birth and delays of 60 -180 s can have significant effects on the volumes of blood transferred to the baby at birth. Jahazi et al [13] note that when the umbilical cord is clamped immediately, as much as 30% of the neonate's blood can remain in the placenta. For the first 20 -25 seconds of life, blood continues to flow in the umbilical arteries from the newborn to the placenta.…”

Primerjava Prednosti in Slabosti Takojšnje Ter Odložene Prekinitve Popkovnice Pri Novorojenčku

“…V literaturi opisane prednosti OPP pred TPP za donošene otroke so predvsem višja raven hemoglobina in feritina, večje zaloge železa in zmanjšana pojavnost anemije zaradi pomanjkanja že-leza, boljša kardiopulmonalna prilagoditev zaradi povečane perfuzije organov in daljše trajanje zgodnjega dojenja. 4,6,7,12,15,17,18 Omenjajo tudi boljše preživetje pri malariji v endemičnih regijah, zaradi kompetitivnega učinka med svincem in železom pa OPP zniža tudi raven svinca v obtoku v okoljih z onesnaženim zrakom.17 Prav tako predpostavljajo, da imajo zarodne celice v popkovnični krvi številne zaščitne in preventivne učinke v otrokovem razvijajočem se organizmu. Preprečevale naj bi pojav določenih krvnih in imunoloških bolezni.…”