A randomised controlled trial of delayed cord clamping in very low birth weight preterm infants

Rabe, Heike; Wacker, Anne; Hülskamp, Georg; Hörnig-Franz, I; Schulze-Everding, Anne; Harms, Erik; Cirkel, U.; Louwen, Frank; Witteler, Ralf; Schneider, H. P. G.

doi:10.1007/pl00008345

Cited by 149 publications

(121 citation statements)

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“…33 Rabe and colleagues found that preterm infants born at fewer than 33 completed weeks of gestation and who were randomized to delayed cord clamping for 45 seconds had significantly higher hemoglobin in the first 28 days of age with a 50% reduction in the need for packed RBC transfusion compared with preterm infants who had delayed cord clamping for 20 seconds. 34 There was no difference between the groups in phlebotomy blood loss. 34 A small pilot study, using a randomized controlled design, in extremely low-birth weight preterm infants (24-32 completed weeks of gestation) showed that delayed cord clamping (30-45 seconds after birth) was safe with no increase in risk of hypothermia, hyperbilirubinemia, and no delay in intubation compared with similar preterm infants who underwent immediate cord clamping.…”

Section: Preterm Infantsmentioning

confidence: 86%

“…A randomized controlled trial of late preterm infants (34)(35)(36) weeks' gestation at birth) found that delayed cord clamping, defined as clamping of the umbilical cord 3 minutes after birth, was associated with higher neonatal hemoglobin at birth and at 10 weeks of age compared with infants with early cord clamping (within 30 seconds after birth). 28 There were no differences in the blood glucose levels, polycythemia or need for phototherapy between the groups.…”

Section: Preterm Infantsmentioning

confidence: 99%

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Untitled

2017

Amer J Perinatol

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Management of the third stage of labor includes clamping of the umbilical cord after delivery of the infant, use of uterotonic medications (e.g., Pitocin) and controlled traction applied to the umbilical cord, and possibly uterine massage. This review will focus on the first step in the process, that is, cord clamping.It is often useful to be familiar with the historical practice of medicine as it can influence decisions and evaluation of our current practice. Dr. A.C. Beck wrote in 1941, "Often the cord is clamped at once…this practice is reprehensible since it deprives the immature infant of considerable blood, which it otherwise might take up from the placental circulation… Blood in the umbilical cord should be stripped toward the fetus before the umbilical cord is ligated." 1 The practice of immediate cord clamping after delivery of the newborn infant has recently been challenged by the American College of Obstetrics and Gynecology. The Committee on obstetric practice stated that the evidence now supports the routine delay in cord clamping for at least 30 to 60 seconds for all vigorous term and preterm neonates. 2 In addition, the seventh edition of the Textbook on Neonatal Resuscitation now recommends this practice. 3The purpose of this review is to present the evidence in support of delayed clamping of the umbilical cord. First, we will discuss the effects of delayed cord clamping or cord milking on the transitional physiology of neonates. Then, we will review the effects of delayed cord clamping on neonatal outcomes. Delayed Cord Clamping and Transitional PhysiologyOne needs to understand the physiology of cardiovascular and respiratory transition as a foundation for understanding the role of placental transfusion that results from delayed cord clamping. There are several aspects of transitional physiology to be considered including effects of lung expansion, changes in the distribution of cardiac output, and blood volume shifts that could benefit from placental transfusion and the possible benefits of the transfusion of stem cells into the newborn.The fetal circulation allows for only 7 to 8% of cardiac output into the lungs. 4,5 Over 90% of cardiac output supplies the systemic circulation, of which 35% comes from left ventricular output and the remainder through the fetal shunt supplied by the patent ductus arteriosus (PDA) 6 as shown AbstractThis review presents the effects of delayed umbilical cord clamping on neonatal transitional physiology. The effects of delayed cord clamping on short-and long-term neonatal outcomes are then discussed. There is ample evidence over the last 50 years that delayed cord clamping in preterm infants is beneficial for both short-term and long-term outcomes. Providing ventilation in the initial steps of neonatal resuscitation prior to clamping of the umbilical cord has a physiologic basis and results in better outcomes for newborns. The challenge now is to design equipment and strategies that can allow initial resuscitation very close to the mother while the umbilical cor...

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Section: Preterm Infantsmentioning

confidence: 86%

Section: Preterm Infantsmentioning

confidence: 99%

Untitled

2017

Amer J Perinatol

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“…10 15 It is unclear whether these results can be extrapolated to resource poor countries, where low birth weight babies are predominantly growth retarded. About a third of the preterm infants in the study by Rabe et al 10 were growth retarded and equally distributed between delayed cord clamping and immediate clamping. Necrotising enterocolitis was examined in two trials, and the incidence did not differ between delayed and immediate clamping (111 infants, relative risk 0.76 (0.37 to 1.58)).…”

Section: Summary Pointsmentioning

confidence: 90%

“…6 The haematological effects of delayed cord clamping in preterm infants were studied in four randomised controlled trials from industrialised countries. [7][8][9][10] The observation period lasted four to six weeks and comprised the time the infants were admitted to the neonatal intensive care unit. Many of these infants born before 30 weeks of gestation would not have…”

Section: Is Delayed Cord Clamping Associated With Improved Haematologmentioning

confidence: 99%

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A Practical Approach to Timing Cord Clamping In Resource Poor Settings

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2007

Obstetric Anesthesia Digest

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There is little agreement among doctors and midwives about the optimal time to clamp the umbilical cord after birth. The most important points of difference relate to maternal and infant safety. Many healthcare workers worldwide tend to clamp the cord and pass the baby off as quickly as possible. Infants in resource poor settings are the main victims of immediate clamping, as this prevents a cost-free means of boosting their small iron stores.Infant anaemia is common in poor communities, especially where malaria is endemic. In sub-Saharan Africa more than 75% of infants are anaemic before 6 months of age. w1-w3 Infant anaemia is associated with increased mortality w4 w5 and with impaired mental and motor development. w6 Its prevention is of critical importance, and delaying clamping of the umbilical cord could be an effective strategy to reduce anaemia and improve child survival.We propose a practice guideline on cord clamping for resource poor countries for singleton vaginal deliveries, based on published systematic reviews, randomised controlled trials, and biological evidence. Taking account of the safety of mothers and infants, we provide evidence about inclusion and exclusion criteria for delayed cord clamping, optimal timing of clamping, infant position during placental-fetal transfusion, and potential side effects. We present the evidence as a series of structured clinical questions, which identify the population concerned (mothers and infants from resource poor countries), the options being compared (mostly delayed versus immediate cord clamping), and the outcome measures used to measure effectiveness and safety of delayed cord clamping. We also present a practical and simple flow chart for quick reference. Clinical questionsIs delayed cord clamping associated with improved haematological status in infancy? Four randomised controlled trials, all from developing countries, evaluated haemoglobin concentrations in term infants 2-4 months after birth. 2-5 Meta-analysis showed that haemoglobin concentrations were significantly higher after delayed cord clamping (317 infants, weighted mean difference 4.9 g/l (95% confidence interval 2.6 to 7.2 g/l)). The proportion of infants with anaemia was lower with delayed cord clamping (three trials, 127 infants, relative risk 0.53 (95% confidence interval 0.40 to 0.69)). 2 3 5 A large randomised controlled trial from Mexico showed a beneficial effect of delayed cord clamping on infant iron status could be measured six months after birth, although haemoglobin levels were no longer different. 6 The haematological effects of delayed cord clamping in preterm infants were studied in four randomised controlled trials from industrialised countries. 7-10 The observation period lasted four to six weeks and comprised the time the infants were admitted to the neonatal intensive care unit. Many of these infants born before 30 weeks of gestation would not have Summary pointsThere is little agreement about the optimal time to clamp the umbilical cord after birth Delaying clamping of ...

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