Comparison of the Effects of Early Versus Delayed Cord Clamping on Haemoglobin Levels in Neonates Delivered at Term.
Cureus
BACKGROUND:The foetus is connected to the placenta via the umbilical cord, which enters through the abdomen at the umbilicus. A venous catheter for infusion and medication may be inserted via the umbilical vein, as it is directly related to the central circulation. Since delayed cord clamping increases iron storage after birth, it may help prevent anaemia in later infancy. METHODS:This randomized controlled trial was conducted in the Department of Obstetrics and Gynaecology at Aziz Bhatti Shaheed Teaching Hospital, Pakistan, over a period of six months, from August 2021 to January 2022. A total of 70 females were enrolled. The neonates were randomly divided into two groups using the lottery method. In group 1, neonates underwent early cord clamping, while in group 2, neonates underwent delayed cord clamping after delivery. Haemoglobin levels were noted and analysed using IBM SPSS Statistics for Windows, Version 20 (Released 2011; IBM Corp., Armonk, New York). RESULTS:The mean age of patients in the early cord clamping group was 26.80±7.59 years, and in the delayed cord clamping group, it was 28.14±6.12 years. The mean haemoglobin level in the early cord clamping group was 13.84±1.74, while in the delayed cord clamping group, it was 16.34±1.90 (p-value=0.001). CONCLUSION:In neonates born at term, the mean haemoglobin level in the delayed cord clamping group was significantly higher than that in the early cord clamping group.
10.7759/cureus.68714
A global perspective of delayed cord clamping in infants.
Seminars in perinatology
Delayed umbilical cord clamping, DCC, a practice in which the umbilical cord is not clamped immediately after birth, promotes placental transfusion to preterm and term neonates. DCC may improve outcomes in preterm neonates by reducing mortality and blood transfusion requirements and increasing iron stores. Despite the recommendations from multiple governing bodies, including the World Health Organization, research on DCC in LMICs remains limited. Given that iron deficiency is prevalent, and most neonatal deaths occur in LMICs, DCC has the potential to improve outcomes in these settings. This article aims to provide a global perspective on DCC in LMICs and to identify knowledge gaps that offer future research opportunities.
10.1016/j.semperi.2023.151748
Effect of Delayed Versus Early Cord Clamping on Improving Anemia in Term Infants Aged Two Months or Older - A Meta-analysis.
Fu Xin,Dang Dan,Li Siwen,Xu Zhiyan,Wu Hui
Indian pediatrics
OBJECTIVE:To assess the effects of delayed cord clamping (DCC) on hemoglobin (Hb), mean corpuscular volume (MCV) and ferritin level in infants 2 months or older. EVIDENCE ACQUISITION:Meta-analysis of randomized control trials searched systematically from PubMed, Cochrane and Web of science. Trials published from Jan 1,1975 to Mar 12, 2018, no language and country restrictions. Twelve studies were included in this meta-analysis. In total, 993 infants were treated with DCC, while 989 cases received early cord clamping. Delayed cord clamping was defined as umbilical cord clamping time greater than 60s after delivery. Outcomes assed were (i) hemoglobin (Hb), (ii) mean corpuscular volume (MCV) and ferritin level. RESULTS:The results show that DCC increased hemoglobin level (SMD=0.4678 95%CI: [0.1515, 0.7841]), Ferritin level (SMD=2.1450 95%CI: [1.0431, 3.2470]) and MCV (SMD=0.5751 95%CI: [0.1637, 0.9865]) in infants between 2-12 months compared to ECC subject analysis noted the effects of Hb increase was greater in Asian infants. CONCLUSIONS:Delayed cord clamping improved the Hb, MCV and ferritin level of infants after birth.
Effect of delayed cord clamping on stem cell transfusion and hematological parameters in preterm infants with placental insufficiency: a pilot randomized trial.
European journal of pediatrics
The feasibility of delayed cord clamping (DCC) in preterm infants with placental insufficiency (PI) is questionable. We aimed to study the effect of DCC on stem cell transfusion, hematological parameters, and clinical outcomes in preterm infants born to mothers with PI. Preterm infants, < 34 weeks' gestation, born to mothers with PI were randomized based on the timing of umbilical cord clamping into delayed clamping for 60 s (DCC group) or immediate cord clamping (ICC group) groups at time of birth. CD34 percentage as a marker of stem cell transfusion, early and late-onset anemia, hypothermia, hypotension, polycythemia, hyperbilirubinemia, duration of oxygen therapy, bronchopulmonary dysplasia, intra-ventricular hemorrhage, necrotizing enterocolitis, sepsis, mortality, and length of hospital stay were compared between studied groups. We found that peripheral blood CD34 percentage was significantly higher in DCC compared with that in the ICC group (median (IQR) of 0.5 (0.40-0.7) versus 0.35 (0.20-0.5), p = 0.004). Infants in the DCC group had significantly lower episodes of anemia of prematurity at 2 months, red blood cell transfusion, and shorter duration of oxygen therapy compared with those in the ICC group.Conclusion: In conclusion, DCC compared with ICC increased stem cell transfusion and decreased early- and late-onset anemia in preterm infants with placental insufficiency.Trial registration: NCT03731546 www.clinicaltrials.gov What is Known: • Delayed cord clamping has been recommended by the American Academy of Pediatrics as a standard of care practice during delivery of preterm infants. • The feasibility of DCC in preterm infants with placental insufficiency (PI) is uncertain. What is New: • This randomized controlled trial demonstrated that DCC in the delivery room care of preterm infants born to mothers with placental insufficiency increased stem cell transfusion and decreased early- and late-onset anemia.
10.1007/s00431-020-03730-4
Delayed cord clamping in healthy term infants: More harm or good?
Bruckner Marlies,Katheria Anup C,Schmölzer Georg M
Seminars in fetal & neonatal medicine
It is recommended to delay cord clamping in healthy term infants for at least 60- and 180-s in high- and limited-resource environments, as delayed cord clamping lowers the incidence of anemia and iron deficiency and improves neurodevelopment. There are improvements in hemodynamic parameters such as peripheral arterial oxygen saturation, heart rate, cardiac output, and cerebral oxygenation. Historically, delayed cord clamping caused a higher rate of hyperbilirubinemia and phototherapy, but more recent evidence suggests this may no longer be the case. In limited-resource environments delayed cord clamping may reduce anemia and iron deficiency potentially improving neurodevelopmental outcomes. The use of delayed cord clamping in newborn infants with intrauterine growth restriction or monochorionic twins is limited and further evidence is needed before it can be formally recommended.
10.1016/j.siny.2021.101221
The Impact of Umbilical Cord Clamping Time on the Infant Anemia: A Randomized Controlled Trial.
Iranian journal of public health
BACKGROUND:Anemia during infancy causes irreversible physical, cognitive, motor, and behavioral development disorders. This study aimed to determine the effect of delaying umbilical cord clamping time on certain parameters regarding anemia during the infancy. METHODS:This randomized controlled trial was conducted at a university hospital in west of Turkey (Dec 2017-Dec 2018). Overall, 110 participants were evaluated for the research, 65 participants were randomized after excluding those who did not meet the inclusion criteria (intervention=32, control=33). Randomly assigned to delayed clamping (1 min after delivery) or early clamping (in 15 sec after delivery), and followed up until 4 months postpartum. 48-hour hematocrit, bilirubin values, need for phototherapy and hematocrit, hemoglobin values, diagnosis of anemia at the postnatal fourth month were compared between two groups. The data showing normal distribution were assessed using the parametric tests. The level of statistical significance was determined as <0.05. RESULTS:The 48-hour hematocrit and bilirubin levels of the intervention group were significantly higher than the control (<0.01 and <0.05, respectively). No significant difference regarding the need for phototherapy due to postnatal hyperbilirubinemia was observed between the two groups (>0.05). Means of the intervention group hematocrit and hemoglobin levels measured during anemia screening performed at the fourth month were found to be higher than those of the infants in the control group (<0.05 and <0.05, respectively). CONCLUSION:Delaying umbilical cord clamping had a positive impact on the haematological parameters of infants. Clamping the cord at least one minute in birth can be performed to prevent the iron deficit anemia that could be seen during the first years of infants' lives.
10.18502/ijph.v50i5.6116
A clinical study of fetal outcome following early and delayed cord clamping in births associated with anemia in pregnancy.
Journal of family medicine and primary care
Background:As there is a risk for infant anaemia, early cord clamping which is usually performed at 10-15 seconds of delivery was changed to delayed cord clamping for at least for 30 seconds Delayed cord clamping (DCC) increases the blood volume and haemoglobin levels in newborns and reduces risk of iron deficiency anaemia in both term and preterm infants.Early clamping allows cord blood collection in benefit for transplantation of stem cells. Research Objective:To compare levels of haemoglobin, hematocrit and serum ferritin at birth and 4 weeks of age in babies as well as neonatal outcome following early and delayed cord clamping in births associated with anaemia in pregnancy. Study Design:An observational study. Participants:Anaemic pregnant women with period of gestation 32-40 weeks admitted in labour room for delivery were enrolled. Intervention: Grouping of the patients was done according to the timing of the umbilical cord clamping. 1. Early cord clamping (< 60 seconds) 2. Delayed cord clamping (1 - 3 minutes) Of which 58 subjects were in ECC (early cord clamping)and 62 were in DCC (delayed cord clamping)group. Results:There was no significance of ECC or DCC in developing polycythemia, IVH or hyperbilirubinemia or increased need of blood transfusion. The levels of haemoglobin, hematocrit and ferritin levels were showing significant increased among DCC as compared to ECC. Conclusion:Delayed cord clamping significantly increases the levels of haemoglobin, Serum ferritin and hematocrit at 4 weeks of age. It should be recommended in routine practice where it is not contraindicated especially in resource- poor settings.
10.4103/jfmpc.jfmpc_882_21
Premature infants receiving delayed cord clamping with and without cord milking: a randomized control trial.
BMC pediatrics
BACKGROUND:Preterm infants often have long hospital stays and frequent blood tests; they often develop anemia requiring multiple blood transfusions. Placental transfusion via delayed cord clamping (DCC) or umbilical cord milking (UCM) helps increase blood volume. We hypothesized umbilical cord milking (UCM), together with DCC, would be superior in reducing blood transfusions. OBJECTIVES:To compare the effects of DCC and DCC combined with UCM on hematologic outcomes among preterm infants. METHODS:One hundred twenty singleton preterm infants born at 280/7- 336/7 weeks of gestation at Thammasat University Hospital were enrolled in an open-label, randomized, controlled trial. They were placed into three groups (1:1:1) by a block-of-three randomization: DCC for 45 s, DCC with UCM performed before clamping (DCM-B), and DCC with UCM performed after clamping (DCM-A). The primary outcomes were hematocrit levels and number of infants receiving blood transfusions during the first 28 days of life. Intraventricular hemorrhage (IVH) and necrotizing enterocolitis (NEC) were secondary outcomes. Analyses were performed with an intent-to-treat approach. RESULTS:One hundred twenty preterm infants were randomized. There was no statistically significant difference in neonatal outcomes; hematocrit on admission 54.0 ± 5.5, 53.3 ± 6.0, and 54.3 ± 5.8 (p = 0.88), receiving blood transfusions 25%, 20%, and 12.5% (p = 0.24), incidence of NEC 7.5, 0 and 10% (p = 0.78) in the DCC, DCM-B and DCM-A groups, respectively. There were no preterm infants with severe IVH, polycythemia, maternal or neonatal death. CONCLUSION:The placental transfusion techniques utilized, DCC and DCC combined with UCM, provided the same benefits for preterm infants born at GA 28 and 33 weeks in terms of reducing the need for RBC transfusions, severities of IVH and incidence of NEC without increasing comorbidity. TRIAL REGISTRATION:TCTR20190131002 . Registered 31 January 2019-Retrospectively registered.
10.1186/s12887-023-03933-2
A randomized controlled clinical trial on peripartum effects of delayed versus immediate umbilical cord clamping on term newborns.
Ofojebe Chukwuemeka Jude,Eleje George Uchenna,Ikechebelu Joseph Ifeanyichukwu,Okpala Boniface Chukwuneme,Ofojebe Binyelum Adaobi,Ugwu Emmanuel Onyebuchi,Igbodike Emeka Philip,Onwuegbuna Arinze Anthony,Ikwuka David Chibuike,Anikwe Chidebe Christian,Ejikeme Toochukwu Benjamin
European journal of obstetrics, gynecology, and reproductive biology
OBJECTIVES:To compare the hemoglobin and serum bilirubin concentration of term newborn following delayed and immediate umbilical cord clamping. METHODS:A randomized controlled trial of eligible parturients with singleton pregnancy delivered between July 1, 2019 and September 30, 2020 were randomly assigned (1:1 ratio) to either delayed clamping of umbilical cord (60 s after delivery) or immediate clamping (0-15 s) was done. The primary outcome measures included hemoglobin and bilirubin levels of the newborn measured at birth and 48 h of life. Intention-to-treat principle was applied to analysis (www.pactr.org: PACTR201906668876480). RESULTS:One hundred and two newborns were randomized into each group and none was lost to follow-up. Participants in both groups had similar socio-demographic and clinical characteristics. At 0 h of birth, cord blood hemoglobin concentration and total bilirubin values were not significantly different between the two groups (p > 0.05). At 48 h of birth, mean hemoglobin concentration was significantly higher in delayed clamping group than immediate clamping group (16.51 ± 1.71 g/dl vs 15.16 ± 2.27 g/dl; p < 0.001) but total mean bilirubin concentration was not significantly different (3.88 ± 1.54 mg/dl vs 3.71 ± 1.20 mg/dl; p = 0.380). There was no significant difference in postpartum hemorrhage (p = 0.653), neonatal jaundice (p = 0.856), and need for phototherapy (p = 0.561) while respiratory symptoms, polycythemia and anemia were not reported. CONCLUSION:Delayed cord clamping at childbirth is more advantageous for term infants in terms of more hemoglobin concentration compared to traditional immediate cord clamping. The maternal and perinatal complications were either not significantly different or absent.
10.1016/j.ejogrb.2021.04.038
Umbilical Cord Management at Term and Late Preterm Birth: A Meta-analysis.
Gomersall Judith,Berber Slavica,Middleton Philippa,McDonald Susan J,Niermeyer Susan,El-Naggar Walid,Davis Peter G,Schmölzer Georg M,Ovelman Colleen,Soll Roger F,
Pediatrics
CONTEXT:The International Liaison Committee on Resuscitation prioritized scientific review of umbilical cord management at term and late preterm birth. OBJECTIVE:To assess effects of umbilical cord management strategies (clamping timing and cord milking) in infants ≥34 weeks' gestational age. DATA SOURCES:Cochrane Central Register of Controlled Trials, Medline, PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, and trial registries searched July 2019. STUDY SELECTION:Two authors independently assessed eligibility of randomized controlled trials. DATA EXTRACTION:Two authors independently extracted data and assessed evidence certainty (Grading of Recommendations Assessment, Development and Evaluations). RESULTS:We identified 46 studies (9159 women and their infants) investigating 7 comparisons. Compared with early cord clamping (ECC) <30 seconds, delayed cord clamping (DCC) ≥30 seconds (33 studies), intact-cord milking (1 study), and cut-cord milking (2 studies) probably improve hematologic measures but may not affect survival without neurodisability, anemia in early infancy, or maternal postpartum hemorrhage. No differences in major neonatal morbidities are seen in studies comparing methods of optimizing placental transfusion (DCC versus cut-cord milking [3 studies], longer delays in clamping [7 studies], or physiologic parameters [3 studies]). Strategies that promote increased placental transfusion may be associated with greater phototherapy use. Evidence for all outcomes was low or very low certainty. LIMITATIONS:Incompleteness and low certainty of findings limit applicability. CONCLUSIONS:Compared with ECC, DCC or cord milking increases hemoglobin and hematocrit immediately after birth in infants ≥34 weeks' gestational age. The uncertain effects of DCC and cord milking compared with ECC on major morbidities limit usefulness of available evidence for policy and practice.
10.1542/peds.2020-015404
Effectiveness and safety of umbilical cord milking in premature infants: A randomized controlled trial.
Medicine
INTRODUCTION:Both UCM and DCC are used to treat preterm infants, but there is no uniform standard for the length of UCM. The aim of this work was to explore the effectiveness and safety of different umbilical cord milking (UCM) lengths versus delayed cord clamping (DCC). METHODS:We enrolled premature infants from the Affiliated Hospital of Zunyi Medical University between September 2019 and October 2020 with random allocation (1:1:1:1) to the UCM 10 cm, UCM 20 cm, UCM 30 cm, and DCC groups. The primary outcome was hemoglobin at birth. RESULTS:Ultimately, 143 participants completed the trial (UCM 10 cm, n = 35; UCM 20 cm, n = 35; UCM 30 cm, n = 38; DCC, n = 35). The hemoglobin levels were significantly lower at birth in the UCM 10 cm group than in the UCM 20 and 30 cm and DCC groups (182.29 ± 22.15 vs 202.83 ± 21.46, 208.82 ± 20.72, and 198.46 ± 24.92, P = .001, .001, and .003, respectively). The systolic blood pressure and diastolic pressures in the UCM 30 cm group were higher than those in the UCM 10 and 20 cm and DCC groups at birth, postnatal day 3 and postnatal day 7 (P < .05). The occurrence rates of anemia were significantly higher in the UCM 10 cm group than in the UCM 20 and 30 cm and DCC groups (42.9% vs 14.3%, 10.5%, and 14.3%, all P < .0083). There were no significant differences in heart rate or complications among the 4 groups. CONCLUSIONS:A UCM of 20 or 30 cm is a safe, effective operation for preterm infants and could improve blood pressure and hemoglobin levels and reduce anemia.
10.1097/MD.0000000000036121
Effects of delayed cord clamping at different time intervals in late preterm and term neonates: a randomized controlled trial.
European journal of pediatrics
Delayed cord clamping (DCC) at delivery has well-recognized benefits; however, current scientific guidelines lack uniformity in its definition. This parallel-group, three-arm assessor-blinded randomized controlled trial compared the effects of three different timings of DCC at 30, 60, and 120 s on venous hematocrit and serum ferritin levels in late preterm and term neonates not requiring resuscitation. Eligible newborns (n = 204) were randomized to DCC 30 (n = 65), DCC 60 (n = 70), and DCC 120 (n = 69) groups immediately after delivery. The primary outcome variable was venous hematocrit at 24 ± 2 h. Secondary outcome variables were respiratory support, axillary temperature, vital parameters, incidences of polycythemia, neonatal hyperbilirubinemia (NNH), need and duration of phototherapy, and postpartum hemorrhage (PPH). Additionally, serum ferritin levels, the incidence of iron deficiency, exclusive breastfeeding (EBF) rate, and anthropometric parameters were assessed during post-discharge follow-up at 12 ± 2 weeks. Over one-third of the included mothers were anemic. DCC 120 was associated with a significant increase in the mean hematocrit by 2%, incidence of polycythemia, and duration of phototherapy, compared to DCC30 and DCC60; though the incidence of NNH and need for phototherapy was similar. No other serious neonatal or maternal adverse events including PPH were observed. No significant difference was documented in serum ferritin, incidences of iron deficiency, and growth parameters at 3 months even in the presence of a high EBF rate. Conclusion: The standard recommendation of DCC at 30-60 s may be considered a safe and effective intervention in the busy settings of low-middle-income countries with a high prevalence of maternal anemia. Trial registration: Clinical trial registry of India (CTRI/2021/10/037070). What is Known: • The benefits of delayed cord clamping (DCC) makes it an increasingly well-accepted practice in the delivery room. • However, uncertainty continues regarding the optimal timing of clamping; this may be of concern both in the neonate and the mother. What is New: • DCC at 120 s led to higher hematocrit, polycythemia and longer duration of phototherapy, without any difference in serum ferritin, and incidence of iron deficiency. • DCC at 30-60 s may be considered a safe and effective intervention in LMICs.
10.1007/s00431-023-05053-6
Prevention of iron deficiency anemia in infants and toddlers.
Pediatric research
Anemia, defined as a low blood hemoglobin concentration, is a major global public health problem. Identification of anemia is crucial to public health interventions. It is estimated globally that 273 million children under 5 years of age were anemic in 2011, and about ~50% of those cases were attributable to iron deficiency (Lancet Global Health 1:e16-e25, 2013). Iron-deficiency anemia (IDA) in infants adversely impacts short-term hematological indices and long-term neuro-cognitive functions of learning and memory that result in both fatigue and low economic productivity. IDA contributes to death and disability and is an important risk factor for maternal and perinatal mortality, including the risks for stillbirths, prematurity, and low birth weight (Comparative Quantification of Health Risks: Global and Regional Burden of Disease Attributable to Selected Major Risk Factors. Ch. 3 (World Health Organization, Geneva, 2004)). Reduction in early infantile anemia and newborn mortality rates is possible with easily implemented, low- to no-cost intervention such as delayed cord clamping (DCC). DCC until 1-3 min after birth facilitates placental transfusion and iron-rich blood flow to the newborn. DCC, an effective anemia prevention strategy, requires cooperation among health providers involved in childbirth, and a participatory culture change in public health. Public intervention strategies must consider multiple factors associated with anemia listed in this review before designing intervention studies that aim to reduce anemia prevalence in infants and toddlers. IMPACT: Anemia, defined as a low blood hemoglobin concentration, is a major global public health problem and identification of anemia is crucial to public health interventions. Delayed cord clamping (DCC) until 1-3 min after birth facilitates placental transfusion and iron-rich blood flow to the newborn. Reduction in early infantile anemia and newborn mortality rates is possible with easily implemented, low- to no-cost intervention such as DCC.
10.1038/s41390-020-0907-5