From the Guidelines
Delayed cord clamping for 5 or more minutes is recommended for most newborns, as it provides several benefits, including increased blood volume, improved iron stores, and better cardiopulmonary adaptation after birth, despite potential complications such as increased risk of jaundice requiring phototherapy 1.
Benefits of Delayed Cord Clamping
The benefits of delayed cord clamping include:
- Increased blood volume, which helps stabilize blood pressure and improves circulation to vital organs
- Improved iron stores, which can last up to 6 months and reduce the risk of anemia
- Better cardiopulmonary adaptation after birth, which is particularly beneficial for preterm infants
Potential Complications
Potential complications of delayed cord clamping include:
- Increased risk of jaundice requiring phototherapy due to the additional red blood cells that break down and release bilirubin
- Slight delay in providing immediate resuscitation if needed, though this can be mitigated by performing initial resuscitation steps with the cord intact
- Rare cases of polycythemia (excessive red blood cells), which may cause blood hyperviscosity
Recommendation
Based on the most recent and highest quality study, delayed cord clamping for 5 or more minutes is recommended for most healthy term and preterm infants, unless immediate cord clamping is necessary for urgent medical interventions 1.
Evidence Summary
The evidence from the 2022 study published in Circulation supports the benefits of delayed cord clamping, including increased blood volume and improved iron stores, while also acknowledging potential complications such as increased risk of jaundice requiring phototherapy 1. The study concludes that the benefits of delayed cord clamping outweigh the risks for most healthy term and preterm infants.
From the Research
Benefits of Delayed Umbilical Cord Clamping (DCC)
- Higher hemoglobin levels and iron storage in term and preterm infants 2, 3, 4, 5, 6
- Improved neurodevelopment in infants and children 2
- Lower rates of anemia, intraventricular hemorrhage (IVH), chronic lung disease, necrotizing enterocolitis, and late-onset sepsis in preterm infants 2, 3, 4, 5, 6
- Fewer transfusions required for preterm infants 2, 3, 4, 5, 6
- Higher blood pressure in infants 2
Potential Complications of Delayed Umbilical Cord Clamping (DCC)
- Lower Apgar scores in some cases 2
- Neonatal hypothermia of admission 2
- Respiratory distress 2
- Severe jaundice, which may require phototherapy 3, 4, 5, 6
- Reduced chances of obtaining clinically useful cord blood units (CBUs) if DCC is performed for more than 60 seconds 2
Recommendations for Delayed Umbilical Cord Clamping (DCC)
- 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 3, 4, 5, 6
- Institutions and settings may vary in their ability to provide DCC, and decisions should be made by the team caring for the mother-infant dyad 3, 4, 5, 6