Effects and safety of delayed versus early umbilical cord clamping in newborns of HIV-infected mothers

Abstract

Objective: To investigate the effect of a 2 minutes-delayed cord clamp (DCC) versus early cord clamp (ECC) on neonate haemoglobin concentration 24 hours and 1 month after birth, and assess the safety of DCC concerning the risk of HIV infection. Design: Sixty-four mother-infant peers were enrolled. All mothers were on stable ARV therapy. Viral load, CD4 þ count and blood haemoglobin (Hb) concentrations 24 hours before delivery were collected from all mothers and their infants. Methods: All patients were enrolled at the Department of Paediatrics, AO FBF Sacco Hospital in Milan, and were followed until 18 months after birth. Women with haematological diseases and obstetrical complications were excluded. All of 64 mother and infants couples (32 ECC group and 32 DCC group) completed the study. ECC and DCC are defined as application of umbilical clamp within 30 seconds and 120 seconds after birth, respectively. Results: Mean birth weight was significantly higher in the DCC compared with ECC group. Mean Hb levels at birth were significantly higher in DCC than in ECC group (p ¼ .05): this difference persisted at 1 month of life. All newborns showed negative viral load. Conclusions: DCC 2 minutes after birth is proven to be a safe procedure, particularly beneficial in newborns from HIV mothers. The risk of anemia is significantly decreased at 24 hours after birth and persists at age of 1 month without any increased risk of neonatal jaundice or polycitemia. ARTICLE HISTORY

Management of Placental Transfusion to Neonates After Delivery

“…In a randomized study of 64 mother-newborn dyads, Pogliani et al 65 compared the effect of delayed cord clamping (120 seconds) with that of early cord clamping (less than 30 seconds) in term neonates delivered by planned cesarean to mothers on stable antiretroviral therapy. Neonates who received delayed cord clamping had significantly higher mean hemoglobin concentrations at 24 hours and 1 month of age.…”

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

“…In a study on 30 newborn infants with congenital heart disease, delayed cord clamping at 110‐130 seconds after birth showed a trend towards higher peak serum bilirubin levels than early cord clamping at less than 10 seconds . In a controlled before‐and‐after study of 64 newborn infants born to mothers with the human immunodeficiency virus, delayed cord clamping 2 minutes after birth did not result in an increased risk of neonatal jaundice when it was compared with early cord clamping within 30 seconds . Similarly, a cross‐sectional, retrospective study of 398 participants showed no increment in the prevalence of neonatal jaundice or need for phototherapy due to late clamping in newborn infants …”

Italian Recommendations for Placental Transfusion Strategies

“…Newborns exposed to antiretroviral therapy during pregnancy have a higher incidence of neonatal anemia (82); DCC could be effective in increasing hemoglobin concentration in the first weeks of life and reducing the need for iron prophylaxis in infancy. To our knowledge, only one study (84) compared the effect of 2 min DCC to immediate cord clamping on 64 paired mother-newborn peers. All mothers had a negative viral load (<1,000 copies/ml) and received antiretroviral therapy during pregnancy; all newborns were born by scheduled cesarean delivery.…”