Delayed Cord Clamping Improves Preterm Infant Survival Rates by 50%, Study Finds

A new study shows that delayed cord clamping could cut the risk of death among premature babies by half. Cavan Images/Getty Images

• A new study shows that delayed cord clamping, compared to immediate cord clamping, could cut the risk of death among premature babies by half.
• The extra blood from the placenta and improved circulation could explain why waiting a bit longer may increase a premature baby’s chance of survival. 
• The current recommendation to clamp the cord is 30–60 seconds. However, the exact amount of time differs between organizations. 

Delaying the clamping of the umbilical cord of a premature baby may decrease the risk of death, according to new research.

The findings, published in The Lancet on November 14, show that delayed clamping, compared to immediate clamping, could reduce the newborn’s risk of death by more than 50%.

Researchers looked at clinical trial data of thousands of premature babies, analyzing delayed cord clamping versus immediate cord clamping. 

“We found that waiting just a couple of minutes can make a lifetime of a difference for babies that are born prematurely,” first author Dr. Anna Lene Seidler, PhD, a senior research fellow and biostatistician with the NHMRC Clinical Trials Centre (CTC) at the University of Sydney, told Healthline.

“Waiting to clamp the cord is a fairly easy intervention. But, it is important the baby is not just left without care for this time, but instead, initial care is provided with the cord intact. We are already talking to international guideline developers about how these results can be implemented. This will then hopefully guide clinical practice globally very soon,” she said. 

What are the advantages of delayed cord clamping?

The current study demonstrates a reduction in neonatal death after delayed cord clamping.

While further studies are needed to better understand the relationship between delayed cord clamping and the mortality rate of premature babies, a possible explanation could be the extra blood from the placenta.

“Researchers and clinicians are not sure yet, but it is believed that providing an extra supply of blood from the placenta makes the infant less likely to need blood support and/or additional blood transfusions,” said Dr. Susan Dulkerian, chair of Mercy’s Department of Pediatrics and Medical Director of Newborn Services in The Family Childbirth and Children’s Center at Mercy Medical Center. Dr. Dulkrian was not involved in the research.

Dr. Eran Bornstein, the vice chair of Obstetrics and Gynecology at Northwell Lenox Hill Hospital in New York, also not involved in the study, told Healthline the study confirms prior knowledge of the benefits of delayed cord clamping in premature infants.

“The American College of Obstetricians and Gynecologists (ACOG) has therefore recommended this practice and states that ‘delayed umbilical cord clamping is associated with significant neonatal benefits in preterm infants, including improved transitional circulation, better establishment of red blood cell volume, decreased need for blood transfusion, and lower incidence of necrotizing enterocolitis and intraventricular hemorrhage,'” Bornstein noted.

Delayed cord clamping is safe for the mother and baby and is advocated by many organizations as the default practice, Bornstein explained.

How long should you delay cord clamping?

Prior research has noted insufficient evidence to show what duration of delay for cord clamping is best.

“The exact time for delayed cord clamping is controversial and differs between different organizations,” said Bornstein. “Based on the ACOG guidelines many institutions use a 1 minute delay. The current study provides evidence that a longer delay of 2 minutes might provide the best risk reduction.”

There are some unique situations in which immediate cord clamping may be required especially when immediate resuscitation is needed, and safe initial breathing help with the cord intact is not possible, or in a low-income setting with limited medical resources, Bornstein noted. These should be individualized based on the specific scenario and availability of the team to provide neonatal resuscitation in conjunction with delayed clamping.

“An assessment is made at the time an infant is delivered of the stability of the baby and possible need for immediate resuscitation in order to do cord clamping,” Dulkerian explained.

To ensure the health of the mother and child, the current recommendation is 30–60 seconds, Dulkerian added.

What causes early mortality in premature infants?

Breathing difficulties may cause mortality among premature infants.

Seidler explained that further evidence on the most effective methods for helping babies requiring immediate resuscitation at birth is needed. 

“There are some large ongoing studies that will provide further clarity about when and how this care should be provided with the cord intact,” said Seidler. “Whilst we found some encouraging early results for providing resuscitation with the cord intact, additional evidence is needed.”

Other factors affecting a premature infant’s survival is gestational age, or how early the baby was born.

“Extreme prematurity requires a high level of expertise and delivery in a hospital with appropriate NICU [neonatal intensive care unit] facility,” Bornstein said.

The baby’s respiratory health and blood pressure also play a role. “We know that babies with a more stable respiratory status and blood pressure generally do better,” Dulkerian noted.

Of course, a lack of resources such as access to quality care could lead to uncontrolled infections, or lack of breastfeeding or nursing support could contribute to feeding difficulties.

It’s important to note that studies on preterm infant mortality rates are likely conducted in highly-resourced settings where NICUs are available. 

“We would really like to see some research happening in lower-resourced settings to see if babies born prematurely in these settings also benefit from these interventions,” Seidler said.

“There is major potential for this intervention to be very beneficial particularly in low-resource settings to give babies a fighting chance, but currently we just don’t have any studies in these settings so we do not know if this is true.”

Takeaway

Delayed cord clamping could lower the risk of death among premature babies by 50%, compared to immediate cord clamping, a new study reports.

Possible explanations regarding the benefits of waiting to clamp the cord include extra blood from the placenta and improved circulation.

While the exact amount of time varies between organizations, the current recommendation to clamp the cord is 30–60 seconds.

Doctors make individual assessments about delayed cord clamping at the time of delivery to keep the birthing person and newborn safe.

Delayed Cord Clamping Improves Preterm Infant Survival Rates by 50%, Study Finds
Source: Pinoy Lang Sakalam

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