Optimal timing of postpartum oxytocin administration with universal delayed cord clamping - Parallel randomized trials

The optimal timing of cord clamping in asphyxia is not known. Our aims were to determine the effect of ventilation (sustained inflation–SI vs. positive pressure ventilation–V) with early (ECC) or delayed cord clamping (DCC) in asphyxiated near-term lambs. We hypothesized that SI with DCC improves gas exchange and hemodynamics in near-term lambs with asphyxial bradycardia. A total of 28 lambs were asphyxiated to a mean blood pressure of 22 mmHg. Lambs were randomized based on the timing of cord clamping (ECC—immediate, DCC—60 s) and mode of initial ventilation into five groups: ECC + V, ECC + SI, DCC, DCC + V and DCC + SI. The magnitude of placental transfusion was assessed using biotinylated RBC. Though an asphyxial bradycardia model, 2–3 lambs in each group were arrested. There was no difference in primary outcomes, the time to reach baseline carotid blood flow (CBF), HR ≥ 100 bpm or MBP ≥ 40 mmHg. SI reduced pulmonary (PBF) and umbilical venous (UV) blood flow without affecting CBF or umbilical arterial blood flow. A significant reduction in PBF with SI persisted for a few minutes after birth. In our model of perinatal asphyxia, an initial SI breath increased airway pressure, and reduced PBF and UV return with an intact cord. Further clinical studies evaluating the timing of cord clamping and ventilation strategy in asphyxiated infants are warranted.

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Delayed Cord Clamping: A Collaborative Practice to Improve Outcomes

Neonatal Network The Journal of Neonatal Nursing ◽

10.1891/0730-0832.32.5.369 ◽

2013 ◽

Vol 32 (5) ◽

pp. 369-373 ◽

Cited By ~ 1

Author(s):

Patricia Scheans

Keyword(s):

Umbilical Cord ◽

Collaborative Practice ◽

Optimal Timing ◽

Long Term Outcomes ◽

Delayed Cord Clamping ◽

Team Collaboration ◽

Neonatal Nurses ◽

Cord Clamping ◽

Short And Long Term

Delayed cord clamping is a collaboration between the obstetric team and the neonatal team. Although the optimal timing for clamping the umbilical cord after birth continues to be subject to study, delaying clamping for at least 30–60 seconds, with the newborn held at or below the level of the uterus/placenta supports normal physiology and has proven benefits. Practical issues such as thermoregulation and equipment can be overcome with team collaboration and prebriefing planning. Neonatal nurses who attend deliveries are perfectly poised to influence this practice and improve short- and long-term outcomes for their patients.

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Effects of delayed cord clamping on neonatal jaundice, phototherapy and early hematological status in term cesarean section

Italian Journal of Pediatrics ◽

10.1186/s13052-021-01069-6 ◽

2021 ◽

Vol 47 (1) ◽

Author(s):

Hailing Shao ◽

Shichu Gao ◽

Qiujing Lu ◽

Xiaomin Zhao ◽

Ying Hua ◽

...

Keyword(s):

Cesarean Section ◽

Neonatal Jaundice ◽

Maternal Blood ◽

Optimal Timing ◽

Short Term ◽

Delayed Cord Clamping ◽

Term Neonates ◽

Transcutaneous Bilirubin ◽

Cord Clamping ◽

Early Cord Clamping

Abstract Background Delayed cord clamping in full-term neonates is widely recommended, while in practice, it is rarely implemented in cesarean section due to the fear of neonatal jaundice and excessive maternal blood loss. The optimal timing of cord clamping remains uncertain. This study was to fully evaluate the effects of delayed cord clamping on short-term hematological status and jaundice in term neonates delivered by cesarean section. Methods This retrospective study enrolled 796 women, who were allocated into the early cord clamping group (n = 377) and the delayed cord clamping group (n = 419). The latter group was further divided into two subgroups (30–60 s, 61–120 s). The outcomes were neonatal transcutaneous bilirubin levels on 0 to 5 days of life and the rate of phototherapy. For neonates who had blood tests on the first three days of life, their hemoglobin and hematocrit were compared among groups. Results Compared with the early cord clamping group, delayed cord clamping merely increased the transcutaneous bilirubin level of neonates on the day of birth rather than that on the following five days. The heel peripheral blood sample size of 1–3 days in the early cord clamping group was 61, 25 and 33, and in the delayed cord clamping group was 53, 46 and 32, respectively. Delayed cord clamping at 30–60 s resulted in the higher neonatal hemoglobin level on day 3 and an increased rate of neonatal polycythemia, without a higher rate of phototherapy. Delayed cord clamping beyond 60 s did not further improve hematological status in term neonates born by cesarean section. Conclusion In cesarean section, delayed cord clamping for 30–60 s improved the early hematological status of term neonates without the enhanced requirement of phototherapy for neonatal jaundice.

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Immediate effects of clamping of the umbilical cord on the newborns

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20192022 ◽

2019 ◽

Vol 6 (3) ◽

pp. 1251

Author(s):

Muhammad Hassan ◽

Adarsh E. ◽

Sahana Manjunath ◽

Shivtej N. ◽

Archana D. V. ◽

...

Keyword(s):

Umbilical Cord ◽

World Health ◽

Optimal Time ◽

Optimal Timing ◽

Delayed Cord Clamping ◽

Medical College ◽

Cord Clamping ◽

Third Stage ◽

Umbilical Cord Clamping ◽

Health Organization

Background: The optimal timing of cord clamping has been a controversial issue for decades. Most practitioners in developing countries clamp and cut the cord immediately after birth and this takes place during the third stage of labour. World Health Organization advises late cord clamping, however there is a debate on the optimal time for cord clamping. Delayed umbilical cord clamping appears to be beneficial for term and preterm infants.Methods: This observational study was undertaken at Rajarajeswari Medical College and Hospital, Bangalore, Karnataka, India from June 2018 to January 2019.Results: Total 100 neonates were studied of which 48 were females (48%) and 52 were males (52%). 76 babies (76%) were 3 day old in this study and 24 babies were (24%) 4 day old during the study period. 92 babies (92%) didn’t receive phototherapy in this study and 8 babies (8%) required phototherapy during the study period. No babies were polycythemic during this study period. Mean TB was 11.832 whereas mean DB was 0.5. Mean HCT was 56.332 and mean HB was 18.3002.Conclusions: Present study concluded that there are various advantages if authors practiced delayed cord clamping including higher levels of haemoglobin and haematocrit levels.

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Obstetrical and neonatal factors associated with optimal public banking of umbilical cord blood in the context of delayed cord clamping

Clinical & Investigative Medicine ◽

10.25011/cim.v42i3.33093 ◽

2019 ◽

Vol 42 (3) ◽

pp. E56-E63 ◽

Cited By ~ 1

Author(s):

Anna Munro ◽

Daniel J. Corsi ◽

Lisa Martin ◽

Michael Halpenny ◽

Nicholas Dibdin ◽

...

Keyword(s):

Cord Blood ◽

Umbilical Cord ◽

Umbilical Cord Blood ◽

Delayed Cord Clamping ◽

Factors Associated ◽

Cell Counts ◽

Cord Clamping ◽

Newborn Weight ◽

Cord Blood Banks

Purpose: To assess the association of specific newborn and maternal factors with indicators of increased blood-forming capacity in umbilical cord blood to inform strategic collection strategies that could augment the quality of units in public cord blood banks. Methods: Data regarding 268 consecutive cord blood units (CBUs) banked by Canadian Blood Services were analyzed. Multivariate analysis was performed to identify factors associated with markers of hematopoietic potency and likelihood of utilization. Results: Delayed clamping of the cord beyond 60 s was associated with reduced volume collected. Any delay in clamping of the cord was associated with reduced total nucleated cell counts. Newborn weight >4,000 g was also associated with greater blood volume in the collection but not with other measures of hematopoietic potency. Cord blood acidosis at birth (pH

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