Allowing mom and baby to stay physically attached for just a few seconds longer could save that newborn's life, says new research from Baylor University Medical Center's neonatal intensive care unit (NICU).
The research, conducted through Baylor Research Institute (BRI) and to be published in the American Journal of Obstetrics and Gynecology, found that waiting 45 seconds before clamping the umbilical cord reduces a preemie's risk of bleeding in the brain. Cord blood, packed with vital stem cells and immunoglobulins, pumped seconds after birth can help the child's body repair itself naturally, the research found.
Effects of Waiting Were Clear
Throughout history, our ancestors understood the nutrient-rich nature of the umbilical cord and of leaving babies attached to the placenta minutes beyond birth. Some mammals, such as chimpanzees, leave the cord attached for days after delivery, while other animals keep it for longer. Baylor's research links modern medicine to those animal instincts.
In the large-scale study, investigators reviewed 148 very preterm infants (less than 32 weeks' gestation), which were a mix of historic and current cases at Baylor. When comparing infants who were immediately removed from the placenta and had the cord cut with those who had the 45-second delay, the effects of waiting were evident.
"We were impressed by the overall results, especially the significant reduction in intraventricular hemorrhage [bleeding in the brain] by almost 50 percent," said Arpitha Chiruvolu, MD, FAAP, the principal investigator for the study. "There were no adverse effects, and significantly fewer babies who got delayed cord clamping were intubated in the delivery room."
In addition to reducing cranial bleeding, which is a leading cause of premature infant death, delayed cord clamping also reduced the need for early red blood cell transfusions, a technique used for blood loss, iron deficiency and anemia. In non-control babies, physicians followed strict protocol for delayed clamping.
"There Should Be No Hesitation"
Delayed cord clamping has become more popular in full-term infants, but its application to premature babies was previously unclear, mostly because doctors weren't sure if leaving preemies in the placenta could make things worse. This was despite the fact that the American College of Obstetricians and Gynecologists endorsed 30- to 60-second delays for all babies in 2012.
"When we were reviewing literature on delayed cord clamping, we found that it might be associated with good outcomes in preterm [infants], but a large number of hospitals do not have a consistent policy," said Dr. Chiruvolu, a neonatologist on the medical staff at Baylor University Medical Center and quality director for Baylor's NICU. "Still, delayed cord clamping is not widely practiced due to the concern of delaying resuscitation in this vulnerable population."
Previous studies mostly involved fewer participants. Given the large size of BRI's study, the results could give delayed clamping the evidence-based support it needs to become more mainstream.
"This study shows that by coordination between departments of obstetrics and neonatology, strict protocol can be rolled out and consistent performance of delayed cord clamping can lead to good outcomes in preterm [infants] without adverse effects," Dr. Chiruvolu said.
Delaying clamping isn't recommended in all cases, however. Delays longer than a minute have been linked with neonatal jaundice -- which requires onsite phototherapy -- and some infants born with breathing problems need immediate cord cutting and resuscitation.
Barring such special circumstances, though, delayed cord cutting is a viable option.
"There should be no hesitation in performing delayed cord clamping in very preterm [infants]," Dr. Chiruvolu said.
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