Delay Clamping of Cord by 1 to 2 Minutes in Newborn

Highlights

• A lot of oxygen rich placental blood is transferred in the first minute following birth.
• Delaying the clamping of cord by one to two minutes offers major health benefits.

A short wait after birth and before cutting the umbilical cord could benefit most newborns by delivering them a surge of oxygen-rich blood. The research according to an American Academy of Pediatrics (AAP)-endorsed guidance, coming from the American College of Obstetricians and Gynecologists (ACOG) suggest waiting “at least 30 seconds to 60 seconds after birth” for all healthy newborns, which is double the times of what usually happens.

It is common in the U.S. for doctors to cut the cord almost immediately, within 15 to 20 seconds of birth, unless the baby is premature.

The World Health Organization recommends a one minute wait; some other groups say it is OK to wait two minutes, or even five.

A lot of oxygen-rich blood reaches the baby through the umbilical cord shortly after birth in an extra half minute, said Dr. Maria Mascola of ACOG’s Committee on Obstetric Practice. Since much of the placental blood transfers in that first minute and there is an increasing evidence that it has some health benefits.

"While there are various recommendations regarding optimal timing for delayed umbilical cord clamping, there has been increased evidence that shows that the practice in and of itself has clear health benefits for both preterm and term infants," noted Maria A. Mascola, M.D., lead author of the committee opinion.

Why is it Important?

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Dr. Tonse Raju of the National Institutes of Health says that it can give a boost as the baby takes his or her first breath.

In the womb, the placenta acts as the fetus’ lungs. But within seconds of birth, the circulation changes and lungs gets filled with fluid and inflate as the baby inhales air.

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If the umbilical cord is cut too early, the baby misses the access to placental blood in the cord and the extra oxygen, too soon.

“Unfortunately, the value of immediate clamping has never been shown,” said Raju, a perinatology specialist at NIH’s National Institute of Child Health and Human Development.

Health Benefits

Babies born prematurely benefit from longer access to cord blood, with a lower risk of transfusions, anemia and bleeding in the brain.

The blood supplies have important quantities of iron, which can further prevent iron deficiencies in the first year of life of the newborn.

Iron deficiency can account for cognitive, motor and behavioral impairment, due to the irreversible developmental processes that it obstructs.

One study showed waiting 3 minutes to cut the cord led to slightly better early brain development.

The connection also facilitates immunoglobulins, as well as stem cells, which are indispensable for tissue and organ repairs.

It lowers risk of transfusion in preterm infants, due to the better transitional circulation and higher levels of red cells. It also reduces incidence of necrotizing enterocolitis and intraventricular hemorrhage.

Another study, published in the journal Pediatrics, for babies delivered via cesearean section, umbilical cord milking can be employed in improving the circulatory functions.

Precautions

However long the pause, should not interfere with baby's skin time with the mother. Raju recommends telling parents, “While the baby’s nice and warm on your skin, we’ll take our time and then clamp.”

Also if the baby has any respiratory distress and needs emergency intervention, doctors should not delay cutting the cord.

Delayed clamping may increase risk of physiological jaundice in babies. Jaundice is a temporary yellowing of the newborn baby's skin and eyes because of excess bilirubin, a yellow pigment of red blood cells.

Babies do need to be monitored for signs of jaundice and treated when necessary.

The research will appear in the January issue of the journal Obstetrics and Gynecology, under the name of "Delayed Umbilical Cord Clamping After Birth".

Source-Medindia