What is the purpose of delayed cord clamping (DCC) after birth?

Benefits of Delayed Cord Clamping

Delayed cord clamping for at least 3 minutes after birth significantly improves infant hematological status and reduces anemia risk without increasing maternal complications. 1

What is Delayed Cord Clamping?

Delayed cord clamping (DCC) refers to waiting at least 30-60 seconds after birth before clamping and cutting the umbilical cord, with optimal benefits seen when delayed for 3 minutes or longer. This contrasts with early cord clamping (ECC), which is performed within 30 seconds of birth 1.

Key Benefits of Delayed Cord Clamping

Hematological Benefits

• Increases hemoglobin concentrations and improves iron stores in infants for up to 6 months after birth 1
• Reduces the incidence of anemia in the first 4 months of life by approximately 47% (relative risk 0.53) 1
• Provides higher hematocrit levels in both term and preterm infants 2
• Improves iron status measured by ferritin concentration, which may benefit neurodevelopment 3

Benefits for Preterm Infants

• Reduces mortality before discharge (27% reduction) 4
• Decreases the need for blood transfusions in the first 6 weeks of life 1, 4
• Lowers incidence of intraventricular hemorrhage (17% reduction in all grades of IVH) 1, 4
• Reduces rates of necrotizing enterocolitis and late-onset sepsis 5, 6

Long-term Benefits

• May improve neurodevelopmental outcomes due to better iron status 6
• Provides better vascular stability and transitional circulation 5, 6

Optimal Timing and Positioning

Timing Recommendations

• For term infants: Delay cord clamping for at least 3 minutes for optimal placental transfusion 1
• For preterm infants: Delay for at least 30-60 seconds 1, 6
• When immediate resuscitation is required: Aim for at least 60 seconds delay with the infant placed between the mother's legs 1

Infant Positioning

• Position the infant at or below the level of the placenta (0-10 cm below or on mother's abdomen) for optimal placental transfusion 1
• Lowering the infant 30 cm below the placenta level may enhance the placental transfusion effect 1

Safety Considerations

Maternal Safety

• DCC combined with administration of oxytocin immediately after delivery is safe for mothers 1
• Does not increase the risk of postpartum hemorrhage or maternal blood loss 5, 6
• Does not affect the need for maternal blood transfusion whether in cesarean section or vaginal delivery 5

Potential Concerns

• May slightly increase peak bilirubin concentrations in preterm infants, but does not increase the need for phototherapy treatment 1, 5
• May increase risk of asymptomatic polycythemia, but this condition appears to be benign 3
• No evidence of increased risk of symptomatic hyperviscosity syndrome requiring partial exchange transfusion 1

Special Situations

Resuscitation Needs

• When immediate neonatal resuscitation is required, place the infant between the mother's legs and start positive pressure ventilation with the umbilical cord intact 1
• Delay clamping for at least 60 seconds in this scenario 1

Growth-Restricted Infants

• Limited information exists on DCC in growth-restricted babies 1
• The risk for polycythemia in these infants is likely lower in resource-poor countries than in industrialized countries 1

Implementation

• DCC should be considered for every infant, regardless of gestational age 1
• Combine DCC with administration of oxytocin immediately after delivery to reduce maternal blood loss 1
• Proceed with controlled cord traction after clamping the umbilical cord 1

Delayed cord clamping represents a simple, safe, and effective delivery procedure that benefits both term and preterm infants by improving hematological status and reducing complications without increasing maternal risks 5, 6.