Early versus delayed umbilical cord clamping on maternal and neonatal outcomes

Yiyu Qian, Xinxin Ying, Peixin Wang, Zhe Lu, Ying Hua, Yiyu Qian, Xinxin Ying, Peixin Wang, Zhe Lu, Ying Hua

Abstract

Purpose: Policies for timing of cord clamping varied from early cord clamping (ECC) in the first 30 s after birth, to delayed cord clamping (DCC) in more than 30 s after birth or when cord pulsation has ceased. DCC, an inexpensive method allowed physiological placental transfusion. The aim of this article is to review the benefits and the potential harms of early versus delayed cord clamping.

Methods: Narrative overview, synthesizing the findings of the literature retrieved from searches of computerized databases.

Results: Delayed cord clamping in term and preterm infants had shown higher hemoglobin levels and iron storage, the improved infants' and children's neurodevelopment, the lesser anemia, the higher blood pressure and the fewer transfusions, as well as the lower rates of intraventricular hemorrhage (IVH), chronic lung disease, necrotizing enterocolitis, and late-onset sepsis. DCC was seldom associated with lower Apgar scores, neonatal hypothermia of admission, respiratory distress, and severe jaundice. In addition, DCC was not associated with increased risk of postpartum hemorrhage and maternal blood transfusion whether in cesarean section or vaginal delivery. DCC appeared to have no effect on cord blood gas analysis. However, DCC for more than 60 s reduced drastically the chances of obtaining clinically useful cord blood units (CBUs).

Conclusion: Delayed cord clamping in term and preterm infants was a simple, safe, and effective delivery procedure, which should be recommended, but the optimal cord clamping time remained controversial.

Keywords: Delayed cord clamping; Early cord clamping; Maternal outcomes; Prenatal outcomes.

Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Prenatal phthalate exposure is associated with maternal and fetal outcomes including alteration of gonadal hormones and thyroid hormones levels, disruption of circulating levels of total 25(OH)D, cryptorchidism, hypospadias, and shorter anogenital distance in particularly for male newborns, pregnancy loss, preterm birth, preeclampsia, glucose disorders, growth retardation, allergic diseases, and impaired neurodevelopmental (behavioral, cognitive, and psychomotor and neurobehavioral)

References

    1. Committee on Obstetric Practice ACoO, Gynecologists Committee Opinion No. 543: timing of umbilical cord clamping after birth. Obstet Gynecol. 2012;120(6):1522–1526.
    1. Raju TN, Singhal N. Optimal timing for clamping the umbilical cord after birth. Clin Perinatol. 2012;39(4):889–900.
    1. Fogarty M, Osborn DA, Askie L, Seidler AL, Hunter K, Lui K, Simes J, Tarnow-Mordi W. Delayed vs early umbilical cord clamping for preterm infants: a systematic review and meta-analysis. Am J Obstet Gynecol. 2018;218(1):1–18.
    1. Chapman J, Marfurt S, Reid J. Effectiveness of delayed cord clamping in reducing postdelivery complications in preterm infants: a systematic review. J Perinat Neonatal Nurs. 2016;30(4):372–378.
    1. Jaleel R, Deeba F, Khan A. Timing of umbilical cord clamping and neonatal haematological status. J Pak Med Assoc. 2009;59(7):468–470.
    1. Ceriani Cernadas JM, Carroli G, Pellegrini L, Otano L, Ferreira M, Ricci C, Casas O, Giordano D, Lardizabal J. The effect of timing of cord clamping on neonatal venous hematocrit values and clinical outcome at term: a randomized, controlled trial. Pediatrics. 2006;117(4):e779–786.
    1. Chen X, Li X, Chang Y, Li W, Cui H. Effect and safety of timing of cord clamping on neonatal hematocrit values and clinical outcomes in term infants: a randomized controlled trial. J Perinatol. 2017;38(3):251–257.
    1. Mercer JS, Erickson-Owens DA, Collins J, Barcelos MO, Parker AB, Padbury JF. Effects of delayed cord clamping on residual placental blood volume, hemoglobin and bilirubin levels in term infants: a randomized controlled trial. J Perinatol. 2017;37(3):260–264.
    1. Emhamed M, van Rheenen P, Brabin B. The early effects of delayed cord clamping in term infants born to Libyan mothers. Trop Doct. 2004;34(4):218–222.
    1. Nakagawa M, Ishida Y, Nagaoki Y, Ohta H, Shimabukuro R, Hirata M, Yamanaka M, Kusakawa I. Correlation between umbilical cord hemoglobin and rate of jaundice requiring phototherapy in healthy newborns. Pediatr Int. 2015;57(4):626–628.
    1. Grajeda R, Pérez-Escamilla R, Dewey K. Delayed clamping of the umbilical cord improves hematologic status of Guatemalan infants at 2 mo of age. Am J Clin Nutr. 1997;65(2):425–431.
    1. Ertekin AA, Nihan Ozdemir N, Sahinoglu Z, Gursoy T, Erbil N, Kaya E. Term babies with delayed cord clamping: an approach in preventing anemia (.) J Matern Fetal Neonatal Med. 2016;29(17):2813–2816.
    1. Tiemersma S, Heistein J, Ruijne R, Lopez G, van Lobenstein J, van Rheenen P. Delayed cord clamping in South African neonates with expected low birthweight: a randomised controlled trial. Trop Med Int Health. 2015;20(2):177–183.
    1. Chaparro CM, Neufeld LM, Tena Alavez G, Eguia-Líz Cedillo R, Dewey KG. Effect of timing of umbilical cord clamping on iron status in Mexican infants: a randomised controlled trial. Lancet. 2006;367(9527):1997–2004.
    1. Nesheli H, Esmailzadeh S, Haghshenas M, Bijani A, Moghaddams T. Effect of late vs early clamping of the umbilical cord (on haemoglobin level) in full-term neonates. J Pak Med Assoc. 2014;64(11):1303–1305.
    1. Gyorkos TW, Maheu-Giroux M, Blouin B, Creed-Kanashiro H, Casapia M, Aguilar E, Silva H, Joseph SA, Penny ME. A hospital policy change toward delayed cord clamping is effective in improving hemoglobin levels and anemia status of 8-month-old Peruvian infants. J Trop Pediatr. 2012;58(6):435–440.
    1. Kc A, Rana N, Malqvist M, Jarawka Ranneberg L, Subedi K, Andersson O. Effects of delayed umbilical cord clamping vs early clamping on anemia in infants at 8 and 12 months: a randomized clinical trial. JAMA Pediatr. 2017;171(3):264–270.
    1. Andersson O, Hellstrom-Westas L, Andersson D, Domellof M. Effect of delayed versus early umbilical cord clamping on neonatal outcomes and iron status at 4 months: a randomised controlled trial. BMJ. 2011;343:d7157.
    1. van Rheenen P, de Moor L, Eschbach S, de Grooth H, Brabin B. Delayed cord clamping and haemoglobin levels in infancy: a randomised controlled trial in term babies. Trop Med Int Health. 2007;12(5):603–616.
    1. Kaempf J, Tomlinson M, Kaempf A, Wu Y, Wang L, Tipping N, Grunkemeier G. Delayed umbilical cord clamping in premature neonates. Obstet Gynecol. 2012;120(2 Pt 1):325–330.
    1. Dicky O, Ehlinger V, Guyard-Boileau B, Assouline C, Arnaud C, Casper C. Delayed umbilical cord clamping in preterm infants born before 37 weeks of gestation: a prospective observational study. Arch Pediatr. 2017;24(2):118–125.
    1. Liu LY, Feinglass JM, Khan JY, Gerber SE, Grobman WA, Yee LM. Evaluation of introduction of a delayed cord clamping protocol for premature neonates in a high-volume maternity center. Obstet Gynecol. 2017;129(5):835–843.
    1. Strauss R, Mock D, Johnson K, Cress G, Burmeister L, Zimmerman M, Bell E, Rijhsinghani A. A randomized clinical trial comparing immediate versus delayed clamping of the umbilical cord in preterm infants: short-term clinical and laboratory endpoints. Transfusion. 2008;48(4):658–665.
    1. Oh W, Fanaroff AA, Carlo WA, Donovan EF, McDonald SA, Poole WK, Eunice Kennedy Shriver National Institute of Child H, Human Development Neonatal Research N Effects of delayed cord clamping in very-low-birth-weight infants. J Perinatol. 2011;31(Suppl 1):S68–71.
    1. Dipak N, Nanavat R, Kabra N, Srinivasan A, Ananthan A. Effect of delayed cord clamping on hematocrit, and thermal and hemodynamic stability in preterm neonates: a randomized controlled trial. Indian Pediatr. 2017;54(2):112–115.
    1. Nevill E, Meyer MP. Effect of delayed cord clamping (DCC) on breathing and transition at birth in very preterm infants. Early Hum Dev. 2015;91(7):407–411.
    1. Jelin AC, Zlatnik MG, Kuppermann M, Gregorich SE, Nakagawa S, Clyman R. Clamp late and maintain perfusion (CLAMP) policy: delayed cord clamping in preterm infants. J Matern Fetal Neonatal Med. 2016;29(11):1705–1709.
    1. Elimian A, Goodman J, Escobedo M, Nightingale L, Knudtson E, Williams M. Immediate compared with delayed cord clamping in the preterm neonate: a randomized controlled trial. Obstet Gynecol. 2014;124(6):1075–1079.
    1. Ranjit T, Nesargi S, Rao P, Sahoo J, Ashok C, Chandrakala B, Bhat S. Effect of early versus delayed cord clamping on hematological status of preterm infants at 6 wk of age. Indian J Pediatr. 2015;82(1):29–34.
    1. Vesoulis ZA, Rhoades J, Muniyandi P, Conner S, Cahill AG, Mathur AM. Delayed cord clamping and inotrope use in preterm infants. J Matern Fetal Neonatal Med. 2018;31(10):1327–1334.
    1. Mercer J, Vohr B, McGrath M, Padbury J, Wallach M, Oh W. Delayed cord clamping in very preterm infants reduces the incidence of intraventricular hemorrhage and late-onset sepsis: a randomized, controlled trial. Pediatrics. 2006;117(4):1235–1242.
    1. Aziz K, Chinnery H, Lacaze-Masmonteil T. A single-center experience of implementing delayed cord clamping in babies born at less than 33 weeksʼ gestational age. Adv Neonatal Care. 2012;12(6):371–376.
    1. Song D, Jegatheesan P, DeSandre G, Govindaswami B. Duration of cord clamping and neonatal outcomes in very preterm infants. PLoS ONE. 2015;10(9):e0138829.
    1. Chiruvolu A, Qin H, Nguyen ET, Inzer RW. The effect of delayed cord clamping on moderate and early late-preterm infants. Am J Perinatol. 2018;35(3):286–291.
    1. Salae R, Tanprasertkul C, Somprasit C, Bhamarapravatana K, Suwannarurk K. Efficacy of delayed versus immediate cord clamping in late preterm newborns following normal labor: a randomized control trial. J Med Assoc Thail. 2016;99(Suppl 4):S159–165.
    1. Ultee C, van der Deure J, Swart J, Lasham C, van Baar A. Delayed cord clamping in preterm infants delivered at 34 36 weeks' gestation: a randomised controlled trial. Arch Dis Child Fetal Neonatal Ed. 2008;93(1):F20–23.
    1. Kugelman A, Borenstein-Levin L, Riskin A, Chistyakov I, Ohel G, Gonen R, Bader D. Immediate versus delayed umbilical cord clamping in premature neonates born %3c 35 weeks: a prospective, randomized, controlled study. Am J Perinatol. 2007;24(5):307–315.
    1. Fenton C, McNinch NL, Bieda A, Dowling D, Damato E. Clinical outcomes in preterm infants following institution of a delayed umbilical cord clamping practice change. Adv Neonatal Care. 2018;18(3):223–231.
    1. Das B, Sundaram V, Kumar P, Mordi WT, Dhaliwal LK, Das R. Effect of placental transfusion on iron stores in moderately preterm neonates of 30–33 weeks gestation. Indian J Pediatr. 2018;85(3):172–178.
    1. Chopra A, Thakur A, Garg P, Kler N, Gujral K. Early versus delayed cord clamping in small for gestational age infants and iron stores at 3 months of age—a randomized controlled trial. BMC Pediatr. 2018;18(1):234.
    1. Andersson O, Hellstrom-Westas L, Domellof M. Elective caesarean: does delay in cord clamping for 30 s ensure sufficient iron stores at 4 months of age? A historical cohort control study. BMJ Open. 2016;6(11):e012995.
    1. Gupta R, Ramji S. Effect of delayed cord clamping on iron stores in infants born to anemic mothers: a randomized controlled trial. Indian Pediatr. 2002;39(2):130–135.
    1. Beard JL, Connor JR. Iron status and neural functioning. Annu Rev Nutr. 2003;23:41–58.
    1. Kc A, Malqvist M, Rana N, Ranneberg LJ, Andersson O. Effect of timing of umbilical cord clamping on anaemia at 8 and 12 months and later neurodevelopment in late pre-term and term infants; a facility-based, randomized-controlled trial in Nepal. BMC Pediatr. 2016;16:35.
    1. Datta V, Kumar A, Yadav R. A randomized controlled trial to evaluate the role of brief delay in cord clamping in preterm neonates (34–36 weeks) on short-term neurobehavioural outcome. J Trop Pediatr. 2017
    1. Andersson O, Domellöf M, Andersson D, Hellström-Westas L. Effects of delayed cord clamping on neurodevelopment and infection at four months of age: a randomised trial. Acta Paediatr. 2013;102(5):525–531.
    1. Andersson O, Domellof M, Andersson D, Hellstrom-Westas L. Effect of delayed vs early umbilical cord clamping on iron status and neurodevelopment at age 12 months: a randomized clinical trial. JAMA Pediatr. 2014;168(6):547–554.
    1. Andersson O, Lindquist B, Lindgren M, Stjernqvist K, Domellof M, Hellstrom-Westas L. Effect of delayed cord clamping on neurodevelopment at 4 years of age: a randomized clinical trial. JAMA Pediatr. 2015;169(7):631–638.
    1. Mercer JS, Vohr BR, Erickson-Owens DA, Padbury JF, Oh W. Seven-month developmental outcomes of very low birth weight infants enrolled in a randomized controlled trial of delayed versus immediate cord clamping. J Perinatol. 2010;30(1):11–16.
    1. Katheria AC, Brown MK, Faksh A, Hassen KO, Rich W, Lazarus D, Steen J, Daneshmand SS, Finer NN. Delayed cord clamping in newborns born at term at risk for resuscitation: a feasibility randomized clinical trial. J Pediatr. 2017;187(313–317):e311.
    1. Mercer JS, McGrath MM, Hensman A, Silver H, Oh W. Immediate and delayed cord clamping in infants born between 24 and 32 weeks: a pilot randomized controlled trial. J Perinatol. 2003;23(6):466–472.
    1. Rabe H, Wacker A, Hulskamp G, Hornig-Franz I, Schulze-Everding A, Harms E, Cirkel U, Louwen F, Witteler R, Schneider HP. A randomised controlled trial of delayed cord clamping in very low birth weight preterm infants. Eur J Pediatr. 2000;159(10):775–777.
    1. Rabe H, Alvarez JR, Lawn C, Seddon P, Amess PN. A management guideline to reduce the frequency of blood transfusion in very-low-birth-weight infants. Am J Perinatol. 2009;26(3):179–183.
    1. Bolstridge J, Bell T, Dean B, Mackley A, Moore G, Swift C, Viscount D, Paul DA, Pearlman SA. A quality improvement initiative for delayed umbilical cord clamping in very low-birthweight infants. BMC Pediatr. 2016;16(1):155.
    1. Garton T, Hua Y, Xiang J, Xi G, Keep RF. Challenges for intraventricular hemorrhage research and emerging therapeutic targets. Expert Opin Ther Targets. 2017;21(12):1111–1122.
    1. Mercer JS, Erickson-Owens DA, Vohr BR, Tucker RJ, Parker AB, Oh W, Padbury JF. Effects of placental transfusion on neonatal and 18 month outcomes in preterm infants: a randomized controlled trial. J Pediatr. 2016;168(50–55):e51.
    1. Chiruvolu A, Tolia VN, Qin H, Stone GL, Rich D, Conant RJ, Inzer RW. Effect of delayed cord clamping on very preterm infants. Am J Obstet Gynecol. 2015;213(5):676 e671–677.
    1. Tarnow-Mordi W, Morris J, Kirby A, Robledo K, Askie L, Brown R, Evans N, Finlayson S, Fogarty M, Gebski V, Ghadge A, Hague W, Isaacs D, Jeffery M, Keech A, Kluckow M, Popat H, Sebastian L, Aagaard K, Belfort M, Pammi M, Abdel-Latif M, Reynolds G, Ariff S, Sheikh L, Chen Y, Colditz P, Liley H, Pritchard M, de Luca D, de Waal K, Forder P, Duley L, El-Naggar W, Gill A, Newnham J, Simmer K, Groom K, Weston P, Gullam J, Patel H, Koh G, Lui K, Marlow N, Morris S, Sehgal A, Wallace E, Soll R, Young L, Sweet D, Walker S, Watkins A, Wright I, Osborn D, Simes J, Australian Placental Transfusion Study Collaborative G Delayed versus immediate cord clamping in preterm infants. N Engl J Med. 2017;377(25):2445–2455.
    1. Tolosa JN, Park DH, Eve DJ, Klasko SK, Borlongan CV, Sanberg PR. Mankind's first natural stem cell transplant. J Cell Mol Med. 2010;14(3):488–495.
    1. Makley AT, Goodman MD, Belizaire RM, Friend LA, Johannigman JA, Dorlac WC, Lentsch AB, Pritts TA. Damage control resuscitation decreases systemic inflammation after hemorrhage. J Surg Res. 2012;175(2):e75–82.
    1. Kugelman A, Borenstein-Levin L, Kessel A, Riskin A, Toubi E, Bader D. Immunologic and infectious consequences of immediate versus delayed umbilical cord clamping in premature infants: a prospective, randomized, controlled study. J Perinat Med. 2009;37(3):281–287.
    1. Garabedian C, Rakza T, Drumez E, Poleszczuk M, Ghesquiere L, Wibaut B, Depoortere MH, Vaast P, Storme L, Houfflin-Debarge V. Benefits of delayed cord clamping in red blood cell alloimmunization. Pediatrics. 2016;137(3):e20153236.
    1. Winter J, Kattwinkel J, Chisholm C, Blackman A, Wilson S, Fairchild K. Ventilation of preterm infants during delayed cord clamping (VentFirst): a pilot study of feasibility and safety. Am J Perinatol. 2017;34(2):111–116.
    1. Chantry CJ, Blanton A, Tache V, Finta L, Tancredi D. Delayed cord clamping during elective cesarean deliveries: results of a pilot safety trial. Matern Health Neonatol Perinatol. 2018;4:16.
    1. Katheria A, Poeltler D, Durham J, Steen J, Rich W, Arnell K, Maldonado M, Cousins L, Finer N. Neonatal resuscitation with an intact cord: a randomized clinical trial. J Pediatr. 2016;178(75–80):e73.
    1. Backes CH, Huang H, Cua CL, Garg V, Smith CV, Yin H, Galantowicz M, Bauer JA, Hoffman TM. Early versus delayed umbilical cord clamping in infants with congenital heart disease: a pilot, randomized, controlled trial. J Perinatol. 2015;35(10):826–831.
    1. Sun M, Song X, Shi W, Li Y, Shan N, Zhang H. Delayed umbilical cord clamping in cesarean section reduces postpartum bleeding and the rate of severe asphyxia. Clin Exp Obstet Gynecol. 2017;44(1):14–16.
    1. Withanathantrige M, Goonewardene I. Effects of early versus delayed umbilical cord clamping during antepartum lower segment caesarean section on placental delivery and postoperative haemorrhage: a randomised controlled trial. Ceylon Med J. 2017;62(1):5–11.
    1. Lalonde A, Daviss BA, Acosta A, Herschderfer K. Postpartum hemorrhage today: ICM/FIGO initiative 2004–2006. Int J Gynaecol Obstet. 2006;94(3):243–253.
    1. De Paco C, Herrera J, Garcia C, Corbalán S, Arteaga A, Pertegal M, Checa R, Prieto M, Nieto A, Delgado J. Effects of delayed cord clamping on the third stage of labour, maternal haematological parameters and acid-base status in fetuses at term. Eur J Obstet Gynecol Reprod Biol. 2016;207:153–156.
    1. Andersson O, Hellström-Westas L, Andersson D, Clausen J, Domellöf M. Effects of delayed compared with early umbilical cord clamping on maternal postpartum hemorrhage and cord blood gas sampling: a randomized trial. Acta Obstet Gynecol Scand. 2013;92(5):567–574.
    1. Ruangkit C, Leon M, Hassen K, Baker K, Poeltler D, Katheria A. Maternal bleeding complications following early versus delayed umbilical cord clamping in multiple pregnancies. BMC Pregnancy Childbirth. 2018;18(1):131.
    1. Kuo K, Gokhale P, Hackney DN, Ruangkit C, Bhola M, March M. Maternal outcomes following the initiation of an institutional delayed cord clamping protocol: an observational case-control study. J Matern Fetal Neonatal Med. 2018;31(2):197–201.
    1. Wiberg N, Kallen K, Olofsson P. Delayed umbilical cord clamping at birth has effects on arterial and venous blood gases and lactate concentrations. BJOG. 2008;115(6):697–703.
    1. Valero J, Desantes D, Perales-Puchalt A, Rubio J, Diago Almela V, Perales A. Effect of delayed umbilical cord clamping on blood gas analysis. Eur J Obstet Gynecol Reprod Biol. 2012;162(1):21–23.
    1. De Paco C, Florido J, Garrido M, Prados S, Navarrete L. Umbilical cord blood acid-base and gas analysis after early versus delayed cord clamping in neonates at term. Arch Gynecol Obstet. 2011;283(5):1011–1014.
    1. Ciubotariu R, Scaradavou A, Ciubotariu I, Tarnawski M, Lloyd S, Albano M, Dobrila L, Rubinstein P, Grunebaum A. Impact of delayed umbilical cord clamping on public cord blood donations: can we help future patients and benefit infant donors? Transfusion. 2018;58(6):1427–1433.
    1. Allan DS, Scrivens N, Lawless T, Mostert K, Oppenheimer L, Walker M, Petraszko T, Elmoazzen H. Delayed clamping of the umbilical cord after delivery and implications for public cord blood banking. Transfusion. 2016;56(3):662–665.
    1. Frandberg S, Waldner B, Konar J, Rydberg L, Fasth A, Holgersson J. High quality cord blood banking is feasible with delayed clamping practices. The eight-year experience and current status of the national Swedish Cord Blood Bank. Cell Tissue Bank. 2016;17(3):439–448.
    1. Lawton C, Acosta S, Watson N, Gonzales-Portillo C, Diamandis T, Tajiri N, Kaneko Y, Sanberg PR, Borlongan CV. Enhancing endogenous stem cells in the newborn via delayed umbilical cord clamping. Neural Regen Res. 2015;10(9):1359–1362.
    1. Gokmen Z, Ozkiraz S, Tarcan A, Kozanoglu I, Ozcimen EE, Ozbek N. Effects of delayed umbilical cord clamping on peripheral blood hematopoietic stem cells in premature neonates. J Perinat Med. 2011;39(3):323–329.

Source: PubMed

Sponsorzy i współpracownicy

Warunki medyczne

Interwencje lekowe

3
Subskrybuj