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Toward greater nuance in delayed cord clamping
Laura Marrs1, Susan Niermeyer2
1University of Colorado School of Medicine.
Current Opinion in Pediatrics
|February 7, 2022
Summary
Delayed cord clamping (DCC) offers benefits like improved hemoglobin and survival rates for newborns. Recent research explores alternative techniques and individualized approaches for optimal neonatal outcomes, especially in vulnerable infants.
Area of Science:
- Neonatal Resuscitation
- Perinatal Medicine
- Pediatric Cardiology
Background:
- Delayed cord clamping (DCC) recommended by the International Liaison Committee on Resuscitation for over a decade.
- Variable implementation due to technique consensus and risk concerns in specific populations.
Purpose of the Study:
- Summarize recent literature on benefits and risks of DCC in term and preterm infants.
- Examine alternative cord management techniques: physiologic-based cord clamping, intact cord resuscitation (ICR), and umbilical cord milking (UCM).
Main Methods:
- Review of recent scientific literature on umbilical cord management strategies.
- Analysis of benefits and risks associated with DCC, ICR, and UCM in diverse neonatal populations.
Main Results:
- DCC improves hemoglobin/hematocrit and neurodevelopment in term infants.
- DCC enhances survival in preterm infants; UCM linked to severe intraventricular hemorrhage in extremely preterm infants.
- DCC benefits infants of COVID-19 positive mothers, growth-restricted babies, multiples, and those with cardiopulmonary anomalies.
Conclusions:
- Umbilical cord management is evolving beyond time-based methods to individualized techniques for vulnerable infants.
- Physiologic-based cord clamping and ICR show potential to significantly alter neonatal resuscitation protocols.
- Establishing physiologic equilibrium before cord clamping is crucial for optimizing neonatal outcomes.
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