How Does Delayed Cord Clamping Impact Premature Infant Mortality?

Delaying umbilical cord clamping for two minutes or more after the premature birth of a baby may decrease death risk by over 50%, in contrast to immediate clamping or a shorter delay, according to two new studies published in the journal The Lancet. (1^✔ ✔Trusted Source
Short, medium, and long deferral of umbilical cord clamping compared with umbilical cord milking and immediate clamping at preterm birth

Go to source) For the new findings more than 100 international researchers examined clinical trial data and outcomes of thousands of premature babies, detailed in over 60 studies involving more than 9,000 babies. Delaying clamping of the umbilical cord allows blood to flow from the placenta to the baby whilst the baby’s lungs fill with air. This is thought to help ease the transition to breathing in the infant.

“Worldwide, almost 13 million babies are born prematurely each year and, sadly, close to 1 million die shortly after birth. Our new findings are the best evidence to date that waiting to clamp the umbilical cord can help save the lives of some premature babies,” said Dr. Anna Lene Seidler at the NHMRC Clinical Trials Centre, University of Sydney in Australia.

Delayed Cord Clamping Standard for Full-Term Babies, Uncertainty in Premature Infants

Delayed cord clamping is now recommended routine practice for babies born at full term. However, whilst previous research showed potential benefit for premature babies, best practice for this vulnerable group remained uncertain. Until recently, clinicians generally cut the cord of preterm babies immediately so urgent medical care could be given.

The first paper using data from 3,292 infants across 20 studies found delayed clamping of the umbilical cord, clamped 30 seconds or more after birth, likely reduced the risk of death in premature babies by a third compared to those whose umbilical cord was clamped immediately after birth.

In a subgroup of premature babies where infants were born before 32 weeks of pregnancy, 44.9 percent of the babies with immediate cord clamping experienced hypothermia after birth, compared to 51.2 percent of those with delayed clamping. The average difference in temperature between the deferred clamping group and the immediate clamping group was -0.13 °C.

Reducing Premature Baby Mortality with Delayed Cord Clamping

The second paper analysed data from 47 clinical trials, which involved 6,094 babies, and found waiting at least two minutes before clamping the cord of a premature baby may reduce the risk of death compared with waiting less time to clamp the cord.In comparing different timings, waiting two or more minutes to clamp the cord had a 91 percent probability of being the best treatment to prevent death shortly after birth.

However, the researchers highlight situations where more research is needed on cord clamping. This includes when there are babies requiring immediate resuscitation, unless the hospital is able to provide safe initial breathing help with the cord intact, or in a low-income setting with limited medical resources.

Reference:

1. Short, medium, and long deferral of umbilical cord clamping compared with umbilical cord milking and immediate clamping at preterm birth - (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)02469-8/fulltext?dgcid=raven_jbs_aip_email)

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