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New research suggests that delaying the clamping of the umbilical cord for at least two minutes for premature babies can decrease the risk of death by at least one third.
Postponing the clamping permits the transfer of blood from the placenta to the baby as the baby’s lungs become filled with air.
Specialists recommend that this could potentially make the process of breathing easier and also decrease the chances of the baby developing an iron deficiency.
Based on the recent research published in The Lancet, delaying the procedure for at least two minutes decreases the likelihood of death shortly after birth, in comparison to either immediately cutting the cord or waiting a shorter period of time.
The standard protocol for newborns born at full term in most healthcare systems is to delay clamping of the umbilical cord for approximately one to two minutes.
Previous studies have not definitively determined if this practice is advantageous for premature infants.
According to Dr. Anna Lene Seidler of the NHMRC Clinical Trials Centre at the University of Sydney in Australia, approximately 13 million babies are born prematurely worldwide every year, with nearly one million dying shortly after birth.
Our recent discoveries provide the most compelling proof yet that delaying the clamping of the umbilical cord can potentially rescue the lives of certain premature infants.
“We are currently collaborating with international organizations that develop guidelines in order to incorporate these findings into updated guidelines and clinical practices in the near future.”
NHS England has reported evidence that shows a decreased risk of death by almost one-third for babies born before 34 weeks when the clamping of the cord is delayed for at least 60 seconds after birth.
The scientists analyzed over 60 studies involving over 10,000 infants, creating one of the most extensive databases in this area of research.
One study observed the effects of various cord clamping methods on the mortality rates of premature infants, while another study examined the timing of cord clamping.
The initial analysis consisted of information gathered from 21 studies that examined the effects of delayed versus immediate umbilical cord clamping in a total of 3,292 infants.
In the groups that used deferred clamping, the delay time varied from 30 seconds to over 180 seconds (with certain trials allowing delays of up to five minutes when possible).
The majority of trials in the immediate clamping groups required clamping within 10 seconds. Out of 3292 babies, 1950 (61%) were delivered via caesarean section.
The research showed that out of 1622 babies who had delayed clamping of their umbilical cords, 6% (98) did not survive until discharge from the hospital. In comparison, 8.2% (134) of the 1641 babies whose cords were cut immediately did not survive.
The results indicate that delaying the clamping of the umbilical cord may have decreased the likelihood of death in premature infants by 33%, in comparison to clamping it immediately.
In a subset of infants born prematurely before 32 weeks of gestation, 44.9% (449 out of 1001) who received immediate cord clamping had hypothermia after delivery, while 51.2% (509 out of 994) of those with delayed clamping experienced the same.
The study’s senior author, Professor Lisa Askie, emphasized the importance of keeping premature infants warm during delayed umbilical cord clamping.
One possible way to accomplish this is by drying and swaddling the baby while keeping the umbilical cord attached. The dry baby can then be placed on the mother’s bare chest and covered with a blanket, or a bedside warming trolley can be used.
The second portion of the research comprised of 47 experiments involving a combined 6,094 infants.
The concept of deferred clamping was divided into three categories: brief (15-45 seconds), moderate (45-120 seconds), and extended (120 seconds or more).
Delaying cord clamping for at least two minutes, as opposed to immediate clamping, decreased the likelihood of death in premature infants by 66%.
Additional examination indicated that delaying the clamping of the cord for two or more minutes had a 91% likelihood of being the most effective method for preventing infant mortality in premature infants.
According to researchers, promptly clamping had a minimal chance (less than 1%) of being the most effective method for preventing death.
According to Dr. Sol Libesman, who is the main statistician and a research fellow at the NHMRC Clinical Trials Centre, it used to be common to clamp the umbilical cord right after birth for premature infants in order to dry them, wrap them, and potentially provide resuscitation more easily.
“Our research indicates that there is no longer a need for immediate clamping of the umbilical cord. Instead, current evidence suggests that delaying cord clamping for at least two minutes is the most effective method for managing the cord and reducing the likelihood of premature infants dying shortly after delivery.”
The writers suggest that more research is necessary to determine the most effective way to administer prompt care to critically ill premature infants while keeping the umbilical cord intact.