Subscribe to RSS
DOI: 10.1055/s-0037-1603733
Management of the Third Stage of Labor: How Delayed Umbilical Cord Clamping Can Affect Neonatal Outcome
Publication History
01 February 2017
03 May 2017
Publication Date:
07 June 2017 (online)
Abstract
This review presents the effects of delayed umbilical cord clamping on neonatal transitional physiology. The effects of delayed cord clamping on short- and long-term neonatal outcomes are then discussed. There is ample evidence over the last 50 years that delayed cord clamping in preterm infants is beneficial for both short-term and long-term outcomes. Providing ventilation in the initial steps of neonatal resuscitation prior to clamping of the umbilical cord has a physiologic basis and results in better outcomes for newborns. The challenge now is to design equipment and strategies that can allow initial resuscitation very close to the mother while the umbilical cord is still attached to the placenta.
-
References
- 1 Beck AC. How can the obstetrician aid in reducing the mortality of prematurely born infants?. Am J Ob Gyn 1941; 42 (02) 355-364
- 2 Committee on Obstetric Practice. Committee opinion No. 684: delayed umbilical cord clamping after birth. Obstet Gynecol 2017; 129 (01) e5-e10
- 3 Textbook of Neonatal Resuscitation. 7th ed. In: Weiner GM, Zaichkin J. eds. Elk Grove Village, IL: American Academy of Pediatrics and American Heart Association; 2016
- 4 Swanson JR, Sinkin RA. Transition from fetus to newborn. Pediatrv Clin North Am 2015; 62 (02) 329-343
- 5 Dawes GS. Changes in the circulation at birth. Br Med Bull 1961; 17 (02) 148-153
- 6 Lang JA, Pearson JT. , te Pas AB, et al. Ventilation/perfusion mismatch during lung aeration at birth. J Appl Physiol (1985) 2014; 117 (05) 535-543
- 7 Hooper SB, Polglase GR, Roehr CC. Cardiopulmonary changes with aeration of the newborn lung. Paediatr Respir Rev 2015; 16 (03) 147-150
- 8 Iwamoto HS, Teitel D, Rudolph AM. Effects of birth-related events on blood flow distribution. Pediatr Res 1987; 22 (06) 634-640
- 9 Lang JA, Pearson JT, Binder-Heschl C. , et al. Increase in pulmonary blood flow at birth: role of oxygen and lung aeration. J Physiol 2016; 594 (05) 1389-1398
- 10 Rudolph AM. Fetal and neonatal pulmonary circulation. Annu Rev Physiol 1979; 41: 383-395
- 11 Cassin S, Dawes GS, Mott JC, Ross BB, Strang LB. The vascular resistance of the foetal and newly ventilated lung of the lamb. J Physiol 1964; 171: 61-79
- 12 Teitel DF, Iwamoto HS, Rudolph AM. Changes in the pulmonary circulation during birth-related events. Pediatr Res 1990; 27 (4, Pt 1): 372-378
- 13 Crossley KJ, Allison BJ, Polglase GR, Morley CJ, Davis PG, Hooper SB. Dynamic changes in the direction of blood flow through the ductus arteriosus at birth. J Physiol 2009; 587 (Pt 19): 4695-4704
- 14 Bhatt S, Alison BJ, Wallace EM. , et al. Delaying cord clamping until ventilation onset improves cardiovascular function at birth in preterm lambs. J Physiol 2013; 591 (08) 2113-2126
- 15 Polglase GR, Dawson JA, Kluckow M. , et al. Ventilation onset prior to umbilical cord clamping (physiological-based cord clamping) improves systemic and cerebral oxygenation in preterm lambs. PLoS One 2015; 10 (02) e0117504 . Doi: 10.1371/journal.pone.0117504
- 16 Ersdal HL, Linde J, Mduma E, Auestad B, Perlman J. Neonatal outcome following cord clamping after onset of spontaneous respiration. Pediatrics 2014; 134 (02) 265-272
- 17 Díaz-Castro J, Florido J, Kajarabille N. , et al. The timing of cord clamping and oxidative stress in term newborns. Pediatrics 2014; 134 (02) 257-264
- 18 Sommers R, Stonestreet BS, Oh W. , et al. Hemodynamic effects of delayed cord clamping in premature infants. Pediatrics 2012; 129 (03) e667-e672
- 19 Nevill E, Meyer MP. Effect of delayed cord clamping (DCC) on breathing and transition at birth in very preterm infants. Early Hum Dev 2015; 91 (07) 407-411
- 20 Oh W, Lind J, Gessner IH. The circulatory and respiratory adaptation to early and late cord clamping in newborn infants. Acta Paediatr Scand 1966; 55 (01) 17-25
- 21 Oh W, Oh MA, Lind J. Renal function and blood volume in newborn infant related to placental transfusion. Acta Paediatr Scand 1966; 56: 197-210
- 22 Andersson O, Hellström-Westas L, Andersson D, Domellöf M. Effect of delayed versus early umbilical cord clamping on neonatal outcomes and iron status at 4 months: a randomised controlled trial. BMJ 2011; 343: d7157-d7163
- 23 Andersson O, Lindquist B, Lindgren M, Stjernqvist K, Domellöf M, Hellström-Westas L. Effect of delayed cord clamping on neurodevelopment at 4 years of age: a randomized clinical trial. JAMA Pediatr 2015; 169 (07) 631-638
- 24 Hutton EK, Hassan ES. Late vs early clamping of the umbilical cord in full-term neonates: systematic review and meta-analysis of controlled trials. JAMA 2007; 297 (11) 1241-1252
- 25 McDonald SJ, Middleton P, Dowswell T, Morris PS. Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. Cochrane Database Syst Rev 2013; (07) CD004074 . Doi: 10.1002/14651858.CD004074.pub3
- 26 McDonald SJ, Middleton P. Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. Cochrane Database Syst Rev 2008; 2 (02) CD004074 . Doi: 10.1002/14651858.CD004074.pub2
- 27 De Paco C, Herrera J, Garcia C. , et al. Effects of delayed cord clamping on the third stage of labour, maternal haematological parameters and acid-base status in fetuses at term. Eur J Obstet Gynecol Reprod Biol 2016; 207: 153-156
- 28 Ultee CA, van der Deure J, Swart J, Lasham C, van Baar AL. Delayed cord clamping in preterm infants delivered at 34 36 weeks' gestation: a randomised controlled trial. Arch Dis Child Fetal Neonatal Ed 2008; 93 (01) F20-F23
- 29 Kc A, Rana N, Målqvist M, Jarawka Ranneberg L, Subedi K, Andersson O. Effects of delayed umbilical cord clamping vs early clamping on anemia in infants at 8 and 12 months: a randomized clinical trial. JAMA Pediatr 2017; 171 (03) 264-270
- 30 Strauss RG, Mock DM, Johnson K. , et al. Circulating RBC volume, measured with biotinylated RBCs, is superior to the Hct to document the hematologic effects of delayed versus immediate umbilical cord clamping in preterm neonates. Transfusion 2003; 43 (08) 1168-1172
- 31 Strauss RG, Mock DM, Johnson KJ. , et al. A randomized clinical trial comparing immediate versus delayed clamping of the umbilical cord in preterm infants: short-term clinical and laboratory endpoints. Transfusion 2008; 48 (04) 658-665
- 32 Aladangady N, McHugh S, Aitchison TC, Wardrop CA, Holland BM. Infants' blood volume in a controlled trial of placental transfusion at preterm delivery. Pediatrics 2006; 117 (01) 93-98
- 33 Kinmond S, Aitchison TC, Holland BM, Jones JG, Turner TL, Wardrop CA. Umbilical cord clamping and preterm infants: a randomised trial. BMJ 1993; 306 (6871): 172-175
- 34 Rabe H, Wacker A, Hülskamp G. , et al. A randomised controlled trial of delayed cord clamping in very low birth weight preterm infants. Eur J Pediatr 2000; 159 (10) 775-777
- 35 Mercer JS, McGrath MM, Hensman A, Silver H, Oh W. Immediate and delayed cord clamping in infants born between 24 and 32 weeks: a pilot randomized controlled trial. J Perinatol 2003; 23 (06) 466-472
- 36 Mercer JS, Vohr BR, McGrath MM, Padbury JF, Wallach M, Oh W. Delayed cord clamping in very preterm infants reduces the incidence of intraventricular hemorrhage and late-onset sepsis: a randomized, controlled trial. Pediatrics 2006; 117 (04) 1235-1242
- 37 Jelin AC, Zlatnik MG, Kuppermann M, Gregorich SE, Nakagawa S, Clyman R. Clamp late and maintain perfusion (CLAMP) policy: delayed cord clamping in preterm infants. J Matern Fetal Neonatal Med 2016; 29 (11) 1705-1709
- 38 Mercer JS, Vohr BR, Erickson-Owens DA, Padbury JF, Oh W. Seven-month developmental outcomes of very low birth weight infants enrolled in a randomized controlled trial of delayed versus immediate cord clamping. J Perinatol 2010; 30 (01) 11-16
- 39 Mercer JS, Erickson-Owens DA, Vohr BR. , et al. Effects of placental transfusion on neonatal and 18 month outcomes in preterm infants: a randomized controlled trial. J Pediatr 2016; 168: 50-55.e1
- 40 Oh W, Fanaroff AA, Carlo WA, Donovan EF, McDonald SA, Poole WK. ; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Effects of delayed cord clamping in very-low-birth-weight infants. J Perinatol 2011; 31 (Suppl. 01) S68-S71
- 41 Kaempf JW, Tomlinson MW, Kaempf AJ. , et al. Delayed umbilical cord clamping in premature neonates. Obstet Gynecol 2012; 120 (2, Pt 1): 325-330
- 42 Hosono S, Mugishima H, Fujita H. , et al. Umbilical cord milking reduces the need for red cell transfusions and improves neonatal adaptation in infants born at less than 29 weeks' gestation: a randomised controlled trial. Arch Dis Child Fetal Neonatal Ed 2008; 93 (01) F14-F19
- 43 Hosono S, Mugishima H, Fujita H. , et al. Blood pressure and urine output during the first 120 h of life in infants born at less than 29 weeks' gestation related to umbilical cord milking. Arch Dis Child Fetal Neonatal Ed 2009; 94 (05) F328-F331
- 44 Takami T, Suganami Y, Sunohara D. , et al. Umbilical cord milking stabilizes cerebral oxygenation and perfusion in infants born before 29 weeks of gestation. J Pediatr 2012; 161 (04) 742-747
- 45 Rabe H, Jewison A, Alvarez RF. , et al; Brighton Perinatal Study Group. Milking compared with delayed cord clamping to increase placental transfusion in preterm neonates: a randomized controlled trial. Obstet Gynecol 2011; 117 (2, Pt 1): 205-211
- 46 Katheria AC, Truong G, Cousins L, Oshiro B, Finer NN. Umbilical cord milking versus delayed cord clamping in preterm infants. Pediatrics 2015; 136 (01) 61-69
- 47 Al-Wassia H, Shah PS. Efficacy and safety of umbilical cord milking at birth: a systematic review and meta-analysis. JAMA Pediatr 2015; 169 (01) 18-25
- 48 Rabe H, Diaz-Rossello JL, Duley L, Dowswell T. Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes. Cochrane Database Syst Rev 2012; (08) CD003248 . Doi: 10.1002/14651858.CD003248.pub3
- 49 Winter J, Kattwinkel J, Chisholm C, Blackman A, Wilson S, Fairchild K. Ventilation of preterm infants during delayed cord clamping (VentFirst): a pilot study of feasibility and safety. Am J Perinatol 2017; 34 (02) 111-116