Effect of early versus delayed cord clamping in neonate on heart rate, breathing and oxygen saturation during first 10 minutes of birth - randomized clinical trial

Abstract

Background Delayed cord clamping (DCC) after 180 s reduces iron deficiency up to 8 months of infancy compared to babies who received Early Cord Clamping (ECC) at less than 60 s. Experimentally DCC has shown to improve cardio-vascular stability. To evaluate the effect of delayed (≥180 s) group versus early (≤60 s) cord clamping group on peripheral blood oxygenation and heart rate up to 10 min after birth on term and late preterm infants. Methods We conducted a single centred randomized clinical trial in a low risk delivery unit in tertiary Hospital, Nepal. One thousand five hundred ten women, low risk vaginal delivery with foetal heart rate (FHR) ≥ 100 ≤ 160 beats per minute (bpm) and gestational age (≥33 weeks) were enrolled in the study. Participants were randomly assigned to cord clamped ≤60 s of birth and ≥ 180 s. The main outcome measures were oxygen saturation, heart rate from birth to 10 min and time of spontaneous breathing. The oxygen saturation and heart rate, the time of first breath and establishment of regular breathing was analysed using Student t-test to compare groups. We analysed the range of heart rate distributed by different centiles from the time of birth at 30 s intervals until 10 min. Results The oxygen saturation was 18% higher at 1 min, 13% higher at 5 min and 10% higher at 10 min in babies who had cord clamping in delayed group compared to early group ( p < 0.001). The heart rate was 9 beats lower at 1 min and3 beats lower at 5 min in delayed group compared to early group (p < 0.001). Time of first breath and regular breathing was established earlier in babies who had cord clamping at 180 s or more. Conclusion Spontaneously breathing babies subjected to DCC have higher oxygen saturation up to 10 min after birth compared to those who have undergone ECC. Spontaneously breathing babies with DCC have lower heart rates compared to ECC until 390 s. Spontaneously breathing babies receiving DCC have early establishment of breathing compared to ECC. Trial registration ISRCTN , 5 April 2016.

Neonatal care practices in Buikwe District, Uganda: A qualitative study

“…Another study from 2019 found higher levels of Oxygen in babies with delayed cord clamping than in those who had early cord clamping, in addition to slower heart beat and higher Apgar scores (12). Studies have not found an elevated risk of postpartum haemorrhage of the mothers, and the bene ts to the baby is equally high or higher when delivered by Caesarean section (11,12,20,21).…”

“…Detailed description of newborn procedures such as delayed cord clamping, suction, kangaroo care and early initiation of breastfeeding are included, thus our interview guide focused on these stages connected to birth: Monitoring of labour using partograms gives a better indication of labour progress for easy recognition of early complications (9,10). Delayed cord clamping (DCC) refers to clamping later than 60 seconds after birth or when cord pulsation has ceased, contrary to early cord clamping (ECC) which take place within one minute after birth (11,12). Suction of newborns is a method used to clear secretions from the oropharynx and nasopharynx through the application of negative pressure via a suction catheter or bulb syringe, and is not recommended for uncomplicated births (13).…”

Delayed cord clamping was not associated with an increased risk of hyperbilirubinaemia on the day of birth or jaundice in the first 4 weeks

“…Outcomes of the NepCord trial have previously been reported. 9,11 The primary outcome was the haemoglobin levels at 8 months of age, and the secondary outcomes were the ferritin levels at eight and 12 months and the haemoglobin level and neurodevelopment at 12 months of age. The results showed a reduction in anaemia levels in the delayed group at eight and 12 months of age.…”

“…It has also been reported that around 30%‐40% of blood volume, roughly 25‐30 mL/kg, is transfused if early cord clamping is avoided . Sustaining cord circulation for 3 minutes can improve oxygen saturation and Apgar scores in spontaneously breathing babies . It can provide sufficient amounts of iron to reduce iron deficiency for up to 8 months and reduce anaemia for up to 12 months after birth .…”

“…8 Sustaining cord circulation for 3 minutes can improve oxygen saturation and Apgar scores in spontaneously breathing babies. 9 It can provide sufficient amounts of iron to reduce iron deficiency for up to 8 months and reduce anaemia for up to 12 months after birth . 10 Delayed cord clamping has also been shown to have positive effects on neurodevelopment in term-born children at 12 and 48 months of age.…”