BMJ 2015;350:h1155 doi: 10.1136/bmj.h1155 (Published 2 March 2015)
Page 1 of 1
Research News
RESEARCH NEWS Umbilical clamping should be deferred to protect blood flow to newborns, recommends expert review Susan Mayor London
Clamping of the umbilical cord should be deferred rather than carried out immediately after the birth of healthy babies born at full term, recommends an updated review.1 This conclusion was based on evidence that deferral protected blood flow to the baby and improved iron stores in infancy.
The updated scientific impact paper from the Royal College of Obstetricians and Gynaecologists reviewed the latest evidence on the timing of cord clamping. It warned that immediate cord clamping can affect blood flow to the newborn baby and the transition from fetal to neonatal circulation. Immediate clamping, defined as clamping within 30 seconds of birth, has traditionally been recommended as part of active management of the third stage of labour to reduce the risk of major haemorrhage. But the review found that the timing of cord clamping had no major effect on maternal blood loss at the time of birth. It favoured “deferred clamping,” which it defined as not until at least two minutes after birth.
“Immediate clamping became routine practice without rigorous evaluation,” explained Leila Duley, director of the Nottingham Clinical Trials Unit at Nottingham University and the impact paper’s lead author.
In terms of the baby’s health, the report found that immediate clamping reduced the flow of blood to the newborn, potentially depriving them of iron. It warned that iron deficiency in the first few months of life was associated with neurodevelopmental delay. Evidence showed that deferred clamping, occurring at least two minutes after birth, seemed to improve iron stores in infancy. So the report recommended that the baby, once delivered, could be placed on the mother’s abdomen or chest with the cord intact
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and that the timing of clamping should be recorded in medical notes.
“In healthy babies, the evidence supports deferring clamping of the umbilical cord, as this appears to improve iron stores in infancy,” the report advised. It noted that jaundice may be more common after deferred cord clamping but that phototherapy could treat this. The evidence for preterm babies was less clear, although data from trials indicated potential benefit by deferred rather than immediate cord clamping.
“The recent evidence suggests deferred clamping may have benefits for both term and preterm babies. However, there still needs to be large randomised trials with long term follow up,” concluded Duley.
Reviewing what other organisations recommend, the paper said that the National Institute for Health and Care Excellence recommended that for healthy women at term the cord not be clamped in the first 60 seconds and that it should be clamped before five minutes, although women should be supported if they wished this to be delayed further. thebmj.com Research: 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, doi:10.1136/bmj. d7157); Editorial: Delayed cord clamping and improved infant outcomes (BMJ 2011;343:d7127, doi:10.1136/bmj.d7127) 1
Royal College of Obstetricians & Gynaecologists. Clamping of the umbilical cord and placental transfusion: scientific impact paper No 14. 27 Feb 2015. https://www.rcog.org. uk/en/guidelines-research-services/guidelines/sip14.
Cite this as: BMJ 2015;350:h1155 © BMJ Publishing Group Ltd 2015
Subscribe: http://www.bmj.com/subscribe
Page 1 of 1
Research News
RESEARCH NEWS Umbilical clamping should be deferred to protect blood flow to newborns, recommends expert review Susan Mayor London
Clamping of the umbilical cord should be deferred rather than carried out immediately after the birth of healthy babies born at full term, recommends an updated review.1 This conclusion was based on evidence that deferral protected blood flow to the baby and improved iron stores in infancy.
The updated scientific impact paper from the Royal College of Obstetricians and Gynaecologists reviewed the latest evidence on the timing of cord clamping. It warned that immediate cord clamping can affect blood flow to the newborn baby and the transition from fetal to neonatal circulation. Immediate clamping, defined as clamping within 30 seconds of birth, has traditionally been recommended as part of active management of the third stage of labour to reduce the risk of major haemorrhage. But the review found that the timing of cord clamping had no major effect on maternal blood loss at the time of birth. It favoured “deferred clamping,” which it defined as not until at least two minutes after birth.
“Immediate clamping became routine practice without rigorous evaluation,” explained Leila Duley, director of the Nottingham Clinical Trials Unit at Nottingham University and the impact paper’s lead author.
In terms of the baby’s health, the report found that immediate clamping reduced the flow of blood to the newborn, potentially depriving them of iron. It warned that iron deficiency in the first few months of life was associated with neurodevelopmental delay. Evidence showed that deferred clamping, occurring at least two minutes after birth, seemed to improve iron stores in infancy. So the report recommended that the baby, once delivered, could be placed on the mother’s abdomen or chest with the cord intact
For personal use only: See rights and reprints http://www.bmj.com/permissions
and that the timing of clamping should be recorded in medical notes.
“In healthy babies, the evidence supports deferring clamping of the umbilical cord, as this appears to improve iron stores in infancy,” the report advised. It noted that jaundice may be more common after deferred cord clamping but that phototherapy could treat this. The evidence for preterm babies was less clear, although data from trials indicated potential benefit by deferred rather than immediate cord clamping.
“The recent evidence suggests deferred clamping may have benefits for both term and preterm babies. However, there still needs to be large randomised trials with long term follow up,” concluded Duley.
Reviewing what other organisations recommend, the paper said that the National Institute for Health and Care Excellence recommended that for healthy women at term the cord not be clamped in the first 60 seconds and that it should be clamped before five minutes, although women should be supported if they wished this to be delayed further. thebmj.com Research: 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, doi:10.1136/bmj. d7157); Editorial: Delayed cord clamping and improved infant outcomes (BMJ 2011;343:d7127, doi:10.1136/bmj.d7127) 1
Royal College of Obstetricians & Gynaecologists. Clamping of the umbilical cord and placental transfusion: scientific impact paper No 14. 27 Feb 2015. https://www.rcog.org. uk/en/guidelines-research-services/guidelines/sip14.
Cite this as: BMJ 2015;350:h1155 © BMJ Publishing Group Ltd 2015
Subscribe: http://www.bmj.com/subscribe
