Delayed Cord Clamping in VLBW Infants Reduces Intraventricular Hemorrhage
By Clementine Wallace
NEW YORK (Reuters Health) Apr 06 - Waiting 30 to 45 seconds before clamping the umbilical cord of very low birth weight (VLBW) infants -- less than 1500 grams -- seems to protect them against intraventricular hemorrhage and late-onset sepsis, researchers report in the April issue of Pediatrics.
"While countries in Europe tend to wait before clamping these children's umbilical cord, the current practice in the United States is to clamp it immediately after delivery," lead author Judith Mercer told Reuters Health. "There hasn't been a lot of research done in this country on delayed cord clamping, and most studies were limited by small samples."
Evidence is accumulating to suggest that, for VLBW infants, delaying cord clamping and lowering the newborn below the mother's level significantly increase the flow of blood from the placenta to the newborn, according to Mercer, from the University of Rhode Island in Kingston. In their paper, she and her colleagues note that waiting 30 to 45 seconds results in an 8% to 24% increase in blood volume.
"Immediate cord clamping may deprive these infants of essential blood volume, which might result in hypotension and in a poor perfusion of the tissues," Mercer added.
In this study, the primary aim was to compare the effects of delayed cord clamping (DCC) with immediate cord clamping (ICC) on the development of bronchopulmonary dysplasia and necrotizing enterocolitis in infants born before the 32nd week of gestation. The study involved 72 pregnant women who underwent either ICC at 5 to 10 seconds after birth, or DCC 30 to 45 seconds after delivery.
Outcomes showed no significant differences in either bronchopulmonary dysplasia or suspected necrotizing enterocolitis. On the other hand, unanticipated differences were seen between the ICC and the DCC groups in rates of intraventricular hemorrhage and late-onset sepsis.
These differences were significant in male infants (p < 0.05), but female infants did not exhibit the same advantage. Specifically, 2 of the 23 male infants in the DCC group had intraventricular hemorrhage compared to 8 of the 19 in the ICC group. No case of sepsis occurred among the 23 DCC boys, whereas 6 cases occurred among the 19 ICC boys.
The researchers note the "simplicity of the intervention" in improving outcomes of very preterm infants. The team is currently gathering data through the seventh month after delivery, Mercer said.
Pediatrics 2006;117:1235-1241.
Reprinted with Permission
