Health Australia (Commonwealth Union) – Cord clamping is a medical procedure performed during childbirth, specifically at the time of a baby’s delivery. It involves clamping and cutting the umbilical cord, which is the flexible tube-like structure that connects the baby to the placenta in the womb. The umbilical cord serves as the baby’s lifeline during pregnancy, supplying oxygen and nutrients from the mother to the developing fetus.
Two studies led by the University of Sydney provide additional support for the advantages of delayed cord clamping, suggesting that waiting at least two minutes before clamping the umbilical cord of premature infants may significantly reduce the risk of death. In comparison to immediate cord clamping or clamping after a shorter duration, delaying the clamping process could decrease the likelihood of death by more than half.
The recent findings, featured in two companion papers in The Lancet, analyze clinical trial data and outcomes of premature babies, comparing those subjected to delayed cord clamping with those whose cords were immediately clamped after birth.
Delaying the clamping of the umbilical cord makes it possible for the transfer of blood from the placenta to the infant while the baby’s lungs undergo the process of filling with air. This practice is believed to facilitate a smoother transition to breathing for the newborn.
Dr. Anna Lene Seidler, the first author at the NHMRC Clinical Trials Centre, University of Sydney, emphasizes the global impact of premature births, with nearly 13 million occurring annually and almost 1 million resulting in infant mortality. She asserts that these new findings constitute the most compelling evidence to date, indicating that the practice of delayed cord clamping has the potential to save the lives of some premature infants.
“We are already working with international guideline developers to make sure these results are reflected in updated guidelines and clinical practice in the near future.”
Delayed cord clamping has become a standard practice for full-term infants, supported by established recommendations. However, uncertainties persisted regarding the best approach for premature babies, despite previous research, including trials conducted by the University of Sydney, indicating potential benefits. Traditionally, clinicians often opted for immediate cord clamping in preterm births to facilitate prompt medical intervention.
These uncertainties have resulted in divergent recommendations in national and international guidelines. For instance, the Australian and New Zealand Committee on Resuscitation (ANZCOR) suggests delaying cord clamping for at least 30 seconds in preterm infants not requiring resuscitation at birth. On the other hand, the World Health Organization (WHO) and the UK’s National Institute for Health and Care Excellence (NICE) advocate for delayed cord clamping (not earlier than 1 minute after birth) to enhance maternal and infant health and nutrition outcomes.
In cases where resuscitation is necessary for preterm babies, the WHO recommends immediate cord clamping, while ANZCOR refrains from making a specific recommendation due to insufficient evidence.
The latest studies, drawing from the extensive iCOMP collaboration involving over 100 international researchers focused on umbilical cord management, present the largest dataset to date on delayed cord clamping. This collaborative effort, inclusive of data from the substantial APTS trial led by the University of Sydney, may contribute significantly to advancing the understanding of the optimal practices in this critical aspect of newborn care.
The initial paper, drawing from information gathered from 3,292 infants across 20 studies, indicates that delayed clamping of the umbilical cord—specifically, clamping 30 seconds or more after birth—appears to decrease the risk of death in premature babies when contrasted with those whose umbilical cord was promptly clamped immediately after birth.
“We need further research into how to best provide immediate care to the sickest premature babies while the cord is intact. Even for healthier premature babies, it may seem counter-intuitive to some doctors to defer cord clamping when the baby requires care, but with appropriate training and equipment, along with a full team approach involving midwives, doctors and parents, it is possible to successfully defer cord clamping while ensuring the baby is warm, breathing, and cared for,” added Dr Seidler.
