26 November 2012

Delayed umbilical cord clamping may help preemies

Delaying umbilical cord improves some outcomes in preterm infants, according to an opinion issued by ACOG Committee on Obstetric Practice.


Delaying umbilical cord improves some outcomes in preterm infants, according to an opinion issued by The American College of Obstetricians and Gynecologists (ACOG) Committee on Obstetric Practice.

The data are less clear on benefits to term infants, however.

"The Opinion lists the reported benefits with a 30-60 seconds delay in preterm births," said Dr Tonse Raju from National Institutes of Health, Bethesda, Maryland. "No one knows a single 'ideal' time - that is why the Opinion gave a range."

The Committee Opinion, available online now and scheduled for publication in the December issue of Obstetrics and Gynecology, was a collaborative effort with the American Academy of Pediatrics. Dr Raju is the NIH liaison to the American Academy of Pediatrics Committee on Fetus and Newborn.

The idea behind delayed clamping

Several systematic reviews have suggested that in all newborns, clamping the umbilical cord should be delayed for at least 30 to 60 seconds in order to increase blood volume, reduce the need for blood transfusion, decrease the incidence of intracranial haemorrhage in preterm infants, and decrease the frequency of iron deficiency anaemia in term infants.

Despite these reviews, the ideal timing for umbilical cord clamping has yet to be established and remains controversial. In most cases, umbilical cord clamping is performed within 15 to 20 seconds after birth, with the infant maintained at or below the level of the placenta.

Whether delayed umbilical cord clamping affects maternal outcomes remains unclear; more study is needed, according to the statement.

Further study needed

A 2008 Cochrane review cited in the Opinion found that late umbilical cord clamping had positive and negative effects on neonatal outcomes of term infants. Accordingly, the Committee concludes, "insufficient evidence exists to support or to refute the benefits from delayed umbilical cord clamping for term infants that are born in settings with rich resources."

As for preterm infants, clinical trials have shown benefits of delayed umbilical cord clamping, including significant reductions in the incidence of intraventricular haemorrhage and a reduced need for blood transfusions for low blood pressure or anaemia.

"Evidence supports delayed umbilical cord clamping in preterm infants," the Committee concludes. "The single most important clinical benefit for preterm infants is the possibility for a nearly 50% reduction in intraventricular haemorrhage."

Although there is some evidence to support umbilical cord milking in preterm infants, the Opinion cites the need for further study before making definitive recommendations.

"As the Opinion notes up front, the ACOG Committee Opinions are not 'regulations' or 'dictating an exclusive course of treatment,'" Dr Raju said. "It provides existing information, synthesised; thus, individual doctors can make practice decisions."

(Reuters Health, November 2012)

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