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Delayed cord clamping in healthy term infants: More harm or good?
Marlies Bruckner1, Anup C Katheria2, Georg M Schmölzer1
1Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Alberta, Canada; Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.
Insights
Delaying umbilical cord clamping for healthy newborns by 60-180 seconds benefits infant health, reducing anemia and iron deficiency while improving neurodevelopment. This practice shows improved hemodynamic and cerebral oxygenation, with recent evidence refuting historical concerns of increased jaundice.
Area of Science:
- Neonatal Medicine
- Pediatrics
- Public Health
Background:
- Delayed cord clamping (DCC) is increasingly recognized for its benefits in newborns.
- Historically, concerns about hyperbilirubinemia limited DCC adoption.
- Evidence suggests DCC improves infant health outcomes, particularly in resource-variable settings.
Purpose of the Study:
- To summarize the benefits of delayed cord clamping in healthy term infants.
- To evaluate the impact of DCC on infant health and neurodevelopment.
- To assess the safety and efficacy of DCC across different resource environments.
Main Methods:
- Review of current evidence and recommendations on delayed cord clamping.
- Analysis of studies examining hemodynamic and neurodevelopmental outcomes.
- Comparison of outcomes in high-resource versus limited-resource settings.
Main Results:
- Delayed cord clamping (60-180 seconds) is recommended for healthy term infants.
- DCC significantly lowers rates of anemia and iron deficiency.
- Improvements observed in hemodynamic parameters and cerebral oxygenation; historical concerns regarding hyperbilirubinemia appear mitigated by current evidence.
Conclusions:
- Delayed cord clamping is beneficial for healthy term infants, improving iron status and neurodevelopment.
- The practice is recommended in both high- and limited-resource settings.
- Further research is needed for specific populations like intrauterine growth restriction and monochorionic twins.
Abstract:
It is recommended to delay cord clamping in healthy term infants for at least 60- and 180-s in high- and limited-resource environments, as delayed cord clamping lowers the incidence of anemia and iron deficiency and improves neurodevelopment. There are improvements in hemodynamic parameters such as peripheral arterial oxygen saturation, heart rate, cardiac output, and cerebral oxygenation. Historically, delayed cord clamping caused a higher rate of hyperbilirubinemia and phototherapy, but more recent evidence suggests this may no longer be the case. In limited-resource environments delayed cord clamping may reduce anemia and iron deficiency potentially improving neurodevelopmental outcomes. The use of delayed cord clamping in newborn infants with intrauterine growth restriction or monochorionic twins is limited and further evidence is needed before it can be formally recommended.
