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Delaying umbilical cord clamping improves babies’ development

Waiting at least three minutes before clamping the umbilical cord of healthy newborn babies improves their iron levels, and is not linked to jaundice or other complications, a study shows.

BMJ Group News

What do we know already?

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At the moment there is little agreement between doctors about how soon to clamp the umbilical cord after a baby is born.

There is some evidence that waiting for a few minutes after a baby is born, before clamping the umbilical cord, could help prevent babies from having an iron deficiency in the months after birth. But doctors don’t know if this affects the baby in other ways.

Previous studies have suggested it might cause babies to have breathing difficulties, or an increase in red blood cells, which could also lead to neonatal jaundice. This is when babies can’t break down a substance called bilirubin in red blood cells normally. This makes their skin and the whites of their eyes look yellow.

To find out if waiting before clamping the umbilical cord was helpful, researchers randomly assigned 400 babies to either delayed umbilical cord clamping, when midwives waited for at least three minutes after birth to clamp the cord, or to immediate cord clamping, within 10 seconds of birth.

Blood samples were taken from the unclamped umbilical cord of babies in the delayed clamping group within 30 seconds of birth, and from the clamped segment of the umbilical cord within 10 minutes of birth for babies in the early clamping group. The blood was tested for signs of iron deficiency, jaundice, and increased numbers of red blood cells. Babies were tested again at two days and at four months of age.

What does the new study say?

At two days old, two babies who had delayed umbilical cord clamping were anaemic, compared with 10 babies who had their umbilical cords clamped early.

By four months of age, there was no difference in the amount of haemoglobin - or iron - in the blood, or in the number of babies who were anaemic in the two groups.

But babies in the delayed cord clamping group had a higher amount of total body iron, at 9.6 mg/kg, than babies who had their umbilical cords clamped early, who had 8.1 mg/kg of total body iron. Ten babies in the early clamping group had iron deficiency at four months, compared with one baby in the delayed clamping group.

In the delayed clamping group 12 newborns were admitted to the neonatal unit, compared with six in the early clamping group, for illnesses including pneumonia, low blood sugar, and breathing difficulties, but this difference was not more than would be expected purely by chance.

There was also no difference in the number of babies who got or needed treatment for jaundice.

How reliable is the research?

This is one of the largest studies comparing delayed and early umbilical cord clamping, and one of the first done in Europe. This type of study design, a randomised controlled trial, is the most accurate way to compare one kind of treatment with another and is a reliable way to find out which treatment has the best effects.

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