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Effectiveness of Delayed Cord Clamping in Reducing Postdelivery Complications in Preterm Infants: A Systematic Review
Jessica Chapman1, Stephanie Marfurt, Julie Reid
1University of Oklahoma College of Nursing, Oklahoma City (Drs Chapman and Marfurt); and Intregris Baptist Medical Center, Oklahoma City, Oklahoma (Ms Reid).
Insights
Delayed cord clamping in preterm infants improves outcomes by reducing anemia and hemodynamic instability. This practice supports current recommendations for preterm deliveries, enhancing infant health.
Area of Science:
- Neonatal Medicine
- Pediatric Hematology
- Obstetrics
Background:
- Preterm infants face risks of anemia, hemodynamic instability, and intraventricular hemorrhages post-delivery.
- Current practices often involve immediate cord clamping, potentially limiting placental transfusion benefits.
- Optimizing cord clamping strategies is crucial for improving neonatal outcomes.
Purpose of the Study:
- To systematically review the effectiveness of delayed cord clamping in preterm infants.
- To assess the impact of delayed cord clamping on reducing specific postdelivery complications.
- To compare various delayed cord clamping durations and techniques against immediate clamping.
Main Methods:
- Comprehensive literature search of randomized controlled trials, observational, cohort, and before-after studies (1946-2015).
- Searches conducted in Ovid MEDLINE, Embase, and Google Scholar databases.
- Critical appraisal of 27 included studies using Critical Appraisal Skills Program guidelines.
Main Results:
- Delayed cord clamping demonstrated improved outcomes in preterm infants.
- Key benefits observed include better hematocrit/hemoglobin levels and reduced need for blood transfusions.
- Evidence suggests a reduction in hemodynamic instability and intraventricular hemorrhages.
Conclusions:
- Delayed cord clamping is associated with significant benefits for preterm infants.
- Supports the established recommendation for performing delayed cord clamping in preterm deliveries.
- Highlights the importance of cord management for neonatal health and development.
Abstract:
This systematic review evaluates the effectiveness of delayed cord clamping in preterm infants on reducing postdelivery complications of anemia, hemodynamic instability, and the development of intraventricular hemorrhages. Interventions included varying durations of delayed cord clamping with and without cord milking as compared with immediate cord clamping, shorter delays in cord clamping, and delayed cord clamping without cord milking. A comprehensive search of randomized controlled trials, observational, cohort, and before-after studies was conducted between 1946 and 2015 in the electronic databases of Ovid MEDLINE, Embase, and Google Scholar. Studies were critically appraised using the Critical Appraisal Skills Program guidelines. Twenty-seven studies were included in the review from 1997 to 2015 from varying countries. Outcome measures included hematocrit/hemoglobin levels, measured or calculated blood volumes levels, number and volume of blood transfusions, presence of hypotension and need for treatment, and development of intraventricular hemorrhage. Delayed cord clamping can lead to improved outcomes measures in preterm infants. This review supports the current recommendation to perform delayed cord clamping during preterm deliveries.
