From the Guidelines
Delayed cord clamping (DCC) is recommended for all newborns, as it improves cardiovascular transition, iron stores, and neurodevelopment, with a 28% reduction in-hospital mortality in preterm infants, as supported by the most recent evidence 1. The benefits of DCC are numerous, including:
- Improved cardiovascular transition
- Increased iron stores up to 8 months
- Improved neurodevelopment up to 4 years of age in children born at term
- 28% reduction in-hospital mortality in preterm infants
- Reduced risk of intraventricular hemorrhage in preterm infants
- Improved cognitive scores at age 18 months in preterm infants These benefits are achieved by waiting 30-300 seconds in term and 30-180 seconds in preterm neonates before clamping the umbilical cord, as recommended by most international organizations, including the World Health Organization (WHO) 1. The practice of DCC allows for continued blood flow from the placenta to the baby, providing an additional 30-50% blood volume, which helps maintain blood pressure and improves oxygen delivery to tissues. In real-life clinical medicine, DCC is a simple and low-risk intervention that can be implemented without special equipment, making it a valuable practice to improve the health outcomes of newborns, particularly preterm infants 1.
From the Research
Benefits of Delayed Cord Clamping
The benefits of delayed cord clamping (DCC) include:
- Increased hemoglobin levels and iron stores in term and preterm infants 2, 3, 4, 5, 6
- Improved transitional circulation and better establishment of red blood cell volume in preterm infants 4, 5, 6
- Decreased need for blood transfusion in preterm infants 2, 3, 4, 5, 6
- Lower incidence of necrotizing enterocolitis and intraventricular hemorrhage in preterm infants 2, 3, 4, 5, 6
- Improved neurodevelopment in infants and children 3
- Lower rates of anemia, chronic lung disease, and late-onset sepsis in preterm infants 3
Potential Risks and Considerations
Potential risks and considerations of DCC include:
- Small increase in jaundice that requires phototherapy in term infants 2, 4, 5, 6
- Reduced chances of obtaining clinically useful cord blood units (CBUs) if DCC is performed for more than 60 seconds 3
- Potential impact on maternal outcomes, such as postpartum hemorrhage and blood transfusion, although studies have shown no increased risk 3, 4, 5, 6
Recommendations
Professional organizations, including the American College of Obstetricians and Gynecologists, recommend a delay in umbilical cord clamping in vigorous term and preterm infants for at least 30-60 seconds after birth 4, 5, 6