From the Guidelines
Delayed Umbilical Cord Clamping Benefits
Yes, there is a significant benefit to delayed umbilical cord clamping (DCC). It is recommended to delay cutting the umbilical cord for at least 30 seconds to 1 minute after birth, as this allows for the transfer of placental blood to the newborn, increasing their iron stores and potentially improving outcomes 1.
Key Benefits
- Improved cardiovascular transition and increased iron stores up to 8 months in children born at term 1.
- Reduced risk of intraventricular hemorrhage and improved cognitive scores at age 18 months in preterm infants 1.
- 28% reduction in-hospital mortality in preterm infants 1.
Guidelines and Recommendations
The World Health Organization (WHO) and other international organizations recommend delayed cord clamping, with varying timings suggested: 30-300 seconds in term and 30-180 seconds in preterm neonates 1. The American Heart Association and American Academy of Pediatrics also support delayed cord clamping for at least 30 seconds in term and preterm newborns who do not require resuscitation 1.
Clinical Considerations
The exact duration of delayed cord clamping may vary depending on the individual clinical situation and the newborn's overall health. As a general guideline, delayed cord clamping should be performed for 30 seconds to 1 minute, or until the umbilical cord stops pulsating, whichever comes first. In preterm infants, delayed cord clamping for 30 seconds to 1 minute may also reduce the need for blood transfusions and improve circulatory stability 1.
From the Research
Benefits of Delayed Umbilical Cord Clamping
- Delayed umbilical cord clamping (DCC) appears to be beneficial for term and preterm infants, increasing hemoglobin levels at birth and improving iron stores in the first several months of life 2.
- In preterm infants, DCC is associated with significant neonatal benefits, 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 2, 3, 4.
- DCC may also reduce the risk of death before discharge for babies born preterm, and may reduce the number of babies with any grade of intraventricular hemorrhage 4.
- Additionally, DCC has been shown to have no increased risk of postpartum hemorrhage or maternal blood transfusion, whether in cesarean section or vaginal delivery 2, 5.
Potential Risks and Considerations
- There is a small increase in the incidence of jaundice that requires phototherapy in term infants undergoing DCC 2.
- DCC may be associated with lower Apgar scores, neonatal hypothermia of admission, respiratory distress, and severe jaundice, although these findings are not consistent across all studies 5.
- The optimal timing for cord clamping has yet to be established, with some studies recommending a delay of at least 30-60 seconds 2, 3, 6.
- DCC for more than 60 seconds may reduce the chances of obtaining clinically useful cord blood units (CBUs) 5.
Recommendations and Guidelines
- The American College of Obstetricians and Gynecologists recommends a delay in umbilical cord clamping in vigorous term and preterm infants for at least 30-60 seconds after birth 2.
- Other professional organizations also support delayed cord clamping, citing the associated neonatal benefits 3, 6.
- The ability to provide DCC may vary among institutions and settings, and decisions should be made by the team caring for the mother-infant dyad 2.