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Delayed Cord Clamping

WHO: optimal timing of umbilical cord clamping

World Health Organisation – Essential delivery care practices for maternal and newborn health and nutrition

“The first minutes after birth are a very vulnerable period for both mother and newborn. The care that is provided during this time is critical to ensure not only their immediate survival but also to improve their longer-term health and nutrition.” WHO 2007

The information below is copied directly from the WHO guideline “Essential delivery care practices for maternal and newborn health and nutrition“.

Please note that recommendations to clamp the cord at 3 minutes are ubiquitous, however placental transfusion can take longer in some babies. Recent research by Erickson-Owens (2012) has shown that placing the baby immediately skin-to-skin with the mother can slow the transfusion and the cord should not be clamped for at least 5 minutes.

From the WHO guideline:

Optimal timing of umbilical cord clamping

“What is it?

The optimal time to clamp the umbilical cord for all infants regardless of gestational age or fetal weight is when the circulation in the cord has ceased, and the cord is flat and pulseless (approximately 3 minutes or more after birth).(5)

Image from the WHO publication

 

After the infant is delivered and dried with a clean dry cloth, a fully reactive infant may be placed prone on the maternal abdomen and covered with a warm dry blanket until cord pulsations cease and the cord is clamped and cut.

Why is it important?

For the first minutes after birth, there is still circulation from the placenta to the infant, the majority of which occurs within three minutes,(5) generally coinciding with the end of cord pulsations.

Clamping the umbilical cord immediately (within the first 10 to 15 seconds after delivery) prevents the newborn from receiving adequate blood volume and consequently sufficient iron stores.

Immediate cord clamping has been shown to increase the incidence of iron deficiency and anemia during the first half of infancy,(6) with lower birth weight infants and infants born to iron deficient mothers being at particular risk.(7)

Up to 50% of infants in developing countries become anemic by 1 year of life,(8) a condition which can negatively and perhaps irreversibly affect mental and motor development.(9)

According to one longitudinal study, Costa Rican children with chronic iron deficiency in infancy had 10 to 25 point lower cognitive test scores at 19 years of age, when compared to similar children with adequate iron status.(10)

Waiting to clamp the umbilical cord allows a physiological transfer of placental blood to the infant which provides sufficient iron reserves for the first 6 to 8 months of life,(11) preventing or delaying the development of iron deficiency until other interventions—such as the use of iron-fortified foods—can be implemented.

For premature and low birth weight infants, immediate cord clamping can also increase the risk of intraventricular hemorrhage,(12),(13) and late-onset sepsis.(13)

In addition,immediate cord clamping in these infants increases the need for blood transfusions for anemia and low blood pressure.(12)”

References

(reference numbers in this article correspond to guideline)

5. van Rheenen P, Brabin BJ. A practical approach to timing cord clamping in resource poor settings. BMJ 2007;333:954-958.

6.Hutton EK, Hassan ES. Late vs. early clamping of the umbilical cord in full-term neonates: systematic review and meta-analysis of controlled trials. JAMA 2007;297(11):1241-52.

7.Chaparro CM, Neufeld LM, Tena Alavez G, Eguia-Liz Cedillo R, Dewey KG. Effect of timing of umbilical cord clamping on iron status in Mexican infants: a
randomised controlled trial. Lancet 2006;367:1997-2004.

8.Gillespie S, Johnston JL. Expert Consultation on Anemia:Determinants and Interventions. Ottawa: The Micronutrient Initiative, 1998.

9.Lozoff B, Georgieff MK. Iron deficiency and brain development. Semin Pediatr Neurol 2006;13:158-165.

10.Lozoff B, Jimenez E, Smith JB. Double burden of iron deficiency in infancy and low socioeconomic status: a longitudinal analysis of cognitive test scores to
age 19 years. Arch Pediatr Adolesc Med 2006;160(11):1108-1113.

11. Dewey KG, Chaparro CM. Session 4: Mineral metabolism and body composition Iron status of breast-fed infants. ProcNutrSoc 2007;66(3):412-422.

12.Rabe H, Reynolds G, Diaz-Rossello J. Early versus delayed umbilical cord clamping in preterm infants. Cochrane Database Systematic Reviews 2004;Issue 4. Art. No.: CD003248. DOI: 10.1002/14651858.CD003248.pub2.

About Kate Emerson

Kate Emerson is a clinical student pursuing her interest in neonatal transitional physiology and clinical cord clamping practices. Please visit www.cord-clamping.com to read more.

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