Supine versus Prone Position during Delayed Cord Clamping in Infants ≥36 Weeks: A Randomized Trial

Abstract

Objective There is no recommendation in the literature on optimal positioning of the newborn immediately at birth during delayed cord clamping. To evaluate if prone positioning on the mother's chest at birth during delayed cord clamping leads to a higher hematocrit at 30 hours of life compared to supine positioning.

Study Design A randomized unblinded trial comparing prone and supine position of the newborn before umbilical cord clamping. Healthy newborns ≥36 weeks gestational age and born vaginally with cephalic presentation were included. The newborn was randomized to prone or supine position. Umbilical cord clamping was delayed in both groups to 1 minute after birth. The primary outcome was hematocrit at 30 hours of life. As a secondary outcome, cerebral tissue oxygenation (CrSO₂) values were compared between both groups by near infrared spectroscopy.

Results There was no difference in hematocrit at 30 hours of life between supine and prone positions with a mean at 52 and 53.1, respectively, mean difference −1.1 (95% confidence interval:−2.7, 0.5), p = 0.17. Newborns in supine and prone positions had comparable level of CrSO₂ at 30 hours of life with a mean at 84.1 and 82.2, respectively, mean difference 1.9 (−0.2, 4.0), p = 0.07. There was no correlation between hematocrit and CrSO₂ at 30 hours of life (r = 0.14).

Conclusion There was no difference between prone and supine positioning immediately after birth during delayed cord clamping on hematocrit at 30 hours of life. In the absence of clear findings, further studies with assessment of the effect of position on breastfeeding success in the case room, on maternal satisfaction and outcome beyond 30 hours are needed to make adequate recommendations on positioning.

Key Points

• Delayed cord clamping at 60 seconds is recommended at birth, but optimal positioning is unknown.

• A randomized trial was conducted to compare hematocrit at 36 hours of life of prone versus supine position.

• No difference in hematocrit was found in prone versus supine position during delayed cord clamping.

Keywords

birth - prone - supine - position - hematocrit - delayed cord clamping

Clinical Trial Registry Name and Registration Number

This study is registed as supine versus prone position at birth before cord clamping (identifier: NCT03697967).

Data Availability Statement

Deidentified individual participant data will be made available to researchers who make a methodologically sound proposal. Proposals should be submitted to [e-mail].

Authors' Contributions

B.B. and N.A. conceptualized and designed the study, obtained the parents' consents, collected data, drafted the initial manuscript, reviewed and revised the manuscript. L.T., M.S., and A.M. conceptualized and reviewed the manuscript for important intellectual content. R.M. conceptualized, designed the study, and reviewed the manuscript for important intellectual content. All the authors approved the final manuscript as submitted and agreed to be accountable for all aspects of work.

Publication History

Received: 16 February 2023

Accepted: 22 August 2023

Article published online:
19 September 2023

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