Comparison of early umbilical cord clamping v/s delayed cord clamping v/s cord milking on neonatal hemoglobin status - A randomized control study

Abstract Objective This study aimed to determine if delayed cord clamping (DCC) is associated with a reduction in neonatal acute kidney injury (AKI). Study Design A retrospective single-center cohort study of 278 very low birth weight (VLBW) neonates was performed to compare the incidence of AKI in the following groups: immediate cord clamping (ICC), DCC, and umbilical cord milking. AKI was diagnosed by the modified neonatal Kidney Diseases and Improving Global Outcomes (KDIGO) definition. Results The incidence of AKI in the first week was 20.1% with no difference between groups (p = 0.78). After adjustment for potential confounders, the odds of developing AKI, following DCC, compared with ICC was 0.93 (confidence interval [CI]: 0.46–1.86) with no reduction in the stage of AKI between groups. Conclusion In this study, DCC was not associated with a reduced rate of AKI in VLBW neonates. However, the data suggest that DCC is also not harmful to the kidneys, further supporting the safety of DCC in VLBW neonates.

Download Full-text

Epidemiological Investigation on the Current Practice of Umbilical Cord Clamping in China

American Journal of Perinatology ◽

10.1055/s-0040-1721494 ◽

2020 ◽

Author(s):

Juanjuan Zhu ◽

Yujie Xie ◽

Bei Wang ◽

Yiwen Wang ◽

Henry Akinbi ◽

...

Keyword(s):

Health Care ◽

Umbilical Cord ◽

Health Care Providers ◽

Daily Practice ◽

Systemic Circulation ◽

Medical Professional ◽

Care Providers ◽

Delayed Cord Clamping ◽

Cord Clamping ◽

Umbilical Cord Clamping

Objective Despite known benefits, the timing of and method used for umbilical cord clamping (UCC) in neonates remain controversial in China, as well as internationally. The objective of this study was to assess knowledge, attitudes, and practice of UCC amongst health care providers in China, as recommended by medical professional organizations. Study Design A web-based questionnaire on cord clamping practices was administered to midwives, obstetricians, and neonatologists in 126 hospitals from 16 provinces. The provinces were selected from seven different regions of China. Results A total of 5,005 (60.5% of eligible respondents) health care providers returned completed questionnaires. The awareness rates for immediate cord clamping (ICC) and delayed cord clamping (DCC) were over 85%, but the implementation rate for DCC was relatively low (ICC 58.3% vs. DCC 41.6%). Most neonates were placed below the introitus (92.8%) during cord clamping and this correlated with the route of delivery. The choice of UCC was impelled by different factors. Benefits for neonates influenced the choice of ICC (50%) and promoting a larger blood volume to stabilize systemic circulation influenced the choice of DCC (92.3%). Majority (91.5%) of respondents acquiesced that it was necessary to develop national clinical guidelines for UCC. Conclusion The majority of obstetricians, neonatologists, and midwives who participated in this study had a positive perception of DCC. However, this did not translate to daily practice. The practice of UCC is variable and there are no standard guidelines. Key Points

Download Full-text

Management of the Third Stage of Labor: How Delayed Umbilical Cord Clamping Can Affect Neonatal Outcome

American Journal of Perinatology ◽

10.1055/s-0037-1603733 ◽

2017 ◽

Vol 34 (14) ◽

pp. 1375-1381 ◽

Cited By ~ 7

Author(s):

Mitchell Kresch

Keyword(s):

Umbilical Cord ◽

Neonatal Resuscitation ◽

Delayed Cord Clamping ◽

Ample Evidence ◽

Cord Clamping ◽

Third Stage Of Labor ◽

Third Stage ◽

Umbilical Cord Clamping ◽

Short And Long Term

AbstractThis 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.

Download Full-text

Clampeamento do cordão umbilical: uma revisão integrativa da literatura

Enfermagem em Foco ◽

10.21675/2357-707x.2020.v11.n2.2591 ◽

2021 ◽

Vol 11 (4) ◽

Author(s):

Beatriz Boleta Fernandes ◽

Carla Luzia França Araújo

Keyword(s):

Umbilical Cord ◽

Cost Effective ◽

Integrative Review ◽

Delayed Cord Clamping ◽

Cord Clamping ◽

Final Sample ◽

Umbilical Cord Clamping ◽

Practice Method

Objetivo: identificar e sintetizar as evidências disponíveis na literatura sobre o clampeamento do cordão umbilical, e seus resultados evidenciados pela prática. Método: Revisão integrativa da literatura sistematizada em seis etapas, utilizando as bases de dados LILACS, MEDLINE e IBECS e descritores próprios. O período selecionado foi de 2012 a 2018. Resultados: Foram identificados 119 estudos, com uma amostra final composta por 10 estudos selecionados para atender o objetivo proposto. Os estudos apontaram benefícios em relação ao clampeamento tardio do cordão umbilical quando comparado ao clampeamento imediato, tanto em curto prazo, quanto a logo prazo. Conclusão: O clampeamento tardio do cordão umbilical é uma intenção segura de baixo custo e eficaz, e que deve ser incentivada e apoiada no cenário do nascimento.Descritores: Clampeamento; Cordão umbilical; Constrição. UMBILICAL CORD CLAMPING: AN INTEGRATIVE REVIEW OF LITERATUREObjective: To identify and synthesize the evidence available in literature on umbilical cord clamping, and its results evidenced by practice. Method: Integrative review systematized of literature by six steps using the databases LILACS, MEDLINE e IBECS and own descriptors. Results: Found 119 studs, with a final sample consisting of 10 studies selected to meet the propsed objective. Studies have shown benefits over delayed cord clamping compared to immediate cord clamping. Conclusion: Delayed cord clamping it´s a feature effective and cost effective and should be encouraged and supported.Descriptores: Clamping; Umbilical Cord; Constriction. PINZAMIENTO DEL CORDÓN UMBILICAL: UMA REVISIÓN DE LA LITERATURAObjetivo: identificar y sintetizar la evidencia disponible en la literatura sobre el pinzamiento del cordón umbilical, y sus resultados evidenciados por la práctica. Metodo: Revisión integral sistematizada de la literatura, em seis passos, utilizando las bases de datos LILACS, MEDLINE e IBECS y sus descriptores. Resultados: Se encontraram 119 estudios, con uma muestra final que consta 10 estudios seleccionados para cumplir el objetivo propuesto. Los estudios han demostrado beneficios sobre el pinzamiento tardío del cordón umbilical en comparación con el pinzamiento inmediato. Conclusión: El pinzamento tardio del cordón umbilical es uma intención segura, económica y efectiva que debe fomentarse y apoyarse em el parto.Descriptores: Pinzamento; Cordón Umbilical; Constricción.

Download Full-text

A study of effect of delayed and early umbilical cord clamping on neonatal haemoglobin status

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20212160 ◽

2021 ◽

Vol 10 (6) ◽

pp. 2268

Author(s):

Jyoti Jaiswal ◽

Krishna Kumar Dehariya ◽

Devina Nagraj

Keyword(s):

Haemoglobin Level ◽

Umbilical Cord ◽

Delayed Cord Clamping ◽

Cord Clamping ◽

Wide Range ◽

Significant Difference ◽

Early Cord Clamping ◽

Umbilical Cord Clamping ◽

Neonatal Blood ◽

Definition Of

Background: Delayed cord clamping has been supported by physician because it allows for physiological transfer of blood from placenta to the infant and thus permits placenta to newborn transfusion and results in an increased neonatal blood volume at birth. At present there is no standard definition of delayed cord clamping. Clamping time varies significantly between studies and a wide range of parameters were used for clamping of cord.Methods: This was an observational study conducted in a public hospital among 200 uncomplicated full-term pregnancies where 100 each were present in early cord clamping (ECC) and delayed cord clamping (DCC) groups respectively and neonatal haematological parameters studied according to different cord clamping times.Results: There was a significant increase of mean haemoglobin level from 14.8 to 16.0 g/dl from 15 secs to 60 secs and gradual increase of mean haemoglobin level from 16.2 to 16.8 g/dl from 60 secs to 180 secs. There was a highly significant difference between ECC and DCC groups regarding mean haemoglobin level and MCH values. MCV and MCH values were also significantly different in both the groups.Conclusions: We concluded in this study that delayed cord clamping, resulted in improved haemoglobin and other haematocrit levels specially when cord was clamped after first 60 secs. Delayed clamping also reduced the prevalence of neonatal anaemia at 2 days of age. In terms of maternal outcomes, delayed umbilical cord clamping did not increase the risk of postpartum haemorrhage or the need for blood transfusion.

Download Full-text

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.

Download Full-text

A Feasibility Study of a Novel Delayed Cord Clamping Cart

Children ◽

10.3390/children8050357 ◽

2021 ◽

Vol 8 (5) ◽

pp. 357

Author(s):

Neha S. Joshi ◽

Kimber Padua ◽

Jules Sherman ◽

Douglas Schwandt ◽

Lillian Sie ◽

...

Keyword(s):

Umbilical Cord ◽

Neonatal Resuscitation ◽

Low Risk ◽

Professional Organizations ◽

Deficiency Anemia ◽

Delayed Cord Clamping ◽

Team Members ◽

Cord Clamping ◽

Umbilical Cord Clamping ◽

Term Newborns

Delaying umbilical cord clamping (DCC) for 1 min or longer following a neonate’s birth has now been recommended for preterm and term newborns by multiple professional organizations. DCC has been shown to decrease rates of iron deficiency anemia, intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), and blood transfusion. Despite these benefits, clinicians typically cut the umbilical cord without delay in neonates requiring resuscitation and move them to a radiant warmer for further care; this effectively prevents these patients from receiving any benefits from DCC. This study evaluated the feasibility of a delayed cord clamping cart (DCCC) in low-risk neonates born via Cesarean section (CS). The DCCC is a small, sterile cart designed to facilitate neonatal resuscitation while the umbilical cord remains intact. The cart is cantilevered over the operating room (OR) table during a CS, allowing the patient to be placed onto it immediately after birth. For this study, a sample of 20 low-risk CS cases were chosen from the non-emergency Labor and Delivery surgical case list. The DCCC was utilized for 1 min of DCC in all neonates. The data collected included direct observation by research team members, recorded debriefings and surveys of clinicians as well as surveys of patients. Forty-four care team members participated in written surveys; of these, 16 (36%) were very satisfied, 12 (27%) satisfied, 13 (30%) neutral, and 3 (7%) were somewhat dissatisfied with use of the DCCC in the OR. Feedback was collected from all 20 patients, with 18 (90%) reporting that they felt safe with the device in use. This study provides support that utilizing a DCCC can facilitate DCC with an intact umbilical cord.

Download Full-text

202-OR: Basal Insulin Digital Titration App vs. Enhanced Paper Titration Tool: A Randomized Control Study

Diabetes ◽

10.2337/db20-202-or ◽

2020 ◽

Vol 69 (Supplement 1) ◽

pp. 202-OR

Author(s):

ATHENA PHILIS-TSIMIKAS ◽

ADDIE L. FORTMANN ◽

ALESSANDRA BASTIAN ◽

ARATI KANCHI ◽

RICARDO ABAD ◽

...

Keyword(s):

Basal Insulin ◽

Randomized Control Study ◽

Randomized Control ◽

Control Study

Download Full-text

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

Download Full-text