What Is Delayed Cord Clamping?
After delivery, the baby’s umbilical cord should be clamped and cut. Prolongation or extending the duration between delivery and clamping of the baby’s umbilical cord is called deferred or delayed cord clamping. As per WHO's (World Health Organization) recommendation, cord clamping should be delayed for one to three minutes after birth in all cases. Delayed cord clamping (DCC) allows blood passage from the placenta to the baby for one to three minutes, increasing the baby’s iron stores. Studies suggest that immediate cord clamping should only be performed in cases where the newborn requires immediate resuscitation.
What Are the Benefits of Delayed Cord Clamping?
Delayed cord clamping allows extra blood to enter the baby’s circulation.
The benefits of delayed cord clamping include the following:
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Increase in Iron Stores:
The extra blood transferred from the placenta to the baby’s circulation increases the baby’s iron stores. Breastfed infants may require iron supplements to prevent anemia; these extra iron stores reduce the risk of anemia in such infants (formula milk usually contains iron supplements added). Studies suggest a 61% reduction in anemia risk following delayed cord clamping in infants. DCC reduces the risk of iron deficiency anemia.
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Increased Blood Volume:
The extra blood received due to delayed cord clamping increases the blood volume and blood count. It significantly reduces the need for blood transfusion, especially in preterm infants (infants born before 37 weeks of pregnancy). Studies show that DCC increases neonatal blood volume by 30%.
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Reduces Infection Risk:
Along with the extra blood the infant receives by DCC, the baby also receives extra antibodies that help fight infections. It reduces the risk of sepsis and necrotizing enterocolitis.
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Nutritional Benefits:
Iron is an essential micronutrient for child development. It plays an important role in neurological development and immune function. Fully breastfed babies may receive only a small amount of iron through milk. Studies show that DCC provides 75 mg of iron to the infant (sufficient for six months). DCC is extremely useful in cases where the mother has an iron deficiency, and the baby weighs less than 6.61 pounds.
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In Preterm Infants:
Preterm infants benefit more from DCC. DCC increases iron stores in such infants. DCC also reduces the risk of infant sepsis, necrotizing enterocolitis, and intraventricular hemorrhage in preterm infants. As per WHO guidelines, DCC is recommended in preterm infants. Studies show a reduction of 29% in infant sepsis and 62% in necrotizing enterocolitis in preterm infants with DCC.
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Heart Rate and Blood Pressure Stabilization:
Preterm infants are at increased risk of developing intracranial hemorrhage, which can result in long-term complications. DCC improves cardiovascular functioning and stabilizes blood pressure, reducing the risk of intraventricular hemorrhage by 50%.
What Are the Risks or Concerns of Delayed Cord Clamping?
The risks and concerns associated with DCC include the following:
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Jaundice:
Hyperbilirubinemia is characterized by increased bilirubin levels in the blood which occur as a result of red blood cell breakdown. Studies suggest a risk of 4.36% for jaundice (high bilirubin levels leading to yellowing of the skin and eyes) in babies who have undergone DCC, which is not significantly elevated when compared to a risk of 2.74% for jaundice in babies who had early cord clamping. The risk for jaundice associated with DCC is mild and can be easily treated with phototherapy.
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HIV (Human Immunodeficiency Virus):
DCC is recommended for all women as per WHO guidelines, whether the woman is HIV positive or even in cases where the HIV status of the mother is unknown. The additional blood flow for one to three minutes due to DCC has not been found to increase the risk of HIV transmission from the mother to the baby.
WHO recommends DCC practice along with all elements of PMTCT (Prevention of mother-to-child transmission) of HIV. This involves decreasing the HIV viral load in the mother with the help of antiretroviral drugs during pregnancy, birth, and after childbirth.
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Polycythemia:
Studies suggest no increased risk of polycythemia (increased red blood cell count resulting in blood thickening) associated with DCC.
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Respiratory Distress:
There is a concern about transient tachypnea associated with DCC. But studies suggest that DCC infants and infants undergoing early cord clamping are at equal risk of developing respiratory distress.
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Maternal Risk:
There are also concerns about maternal risk (postpartum hemorrhage) associated with DCC. Studies show no evidence of blood loss greater than 500ml between DCC and early cord clamping.
Are All Types of Anemia in Children Are Prevented by DCC?
Anemia can occur in children due to various causes like diarrhea, malaria, and parasitic worm infection, which leads to red blood cell destruction, loss of iron, and increases the body's iron requirement. Measures should be taken to prevent iron deficiency in pregnant women so that the infant's nutritional status is improved. All possible preventive measures should be taken in order to avoid malarial infection, diarrhea, and other infections in infants younger than six months. For anemia prevention, deworming medications, iron supplements, or iron-rich food should be given to infants above six months of age.
What Are the Situations in Which DCC Should Be Avoided?
The situations in which DCC should be avoided include the following:
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DCC should be avoided in the case of monochorionic twins. Monochorionic twins share the same placenta so that blood can be transferred from one twin to the other at delivery time. The risk is even more in cases where one twin has more blood.
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Another situation in which DCC is avoided is in cases where the baby of the mother has some problem during delivery that requires immediate resuscitation or other medical treatment. In such cases, immediate cord clamping may be done.
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DCC is also avoided in cases where there is a tear in the placenta leading to bleeding. If such cases, immediate cord clamping is done to arrest bleeding.
Conclusion
Studies suggest that DCC benefits both term and preterm babies by increasing iron stores and reducing infection risk. The associated concerns and risks are minimal and have no substantial evidence. WHO recommends a one to three-minute DCC for all birth, whether full-term or preterm.
