Delayed umbilical cord clamping offers real benefits to newborns

Throughout history, our ancestors understood the nutrient-rich nature of the umbilical cord and of leaving babies attached to it minutes beyond birth. However, due to the concern for delaying newborn resuscitation and the possibility of increased maternal hemorrhage after birth, delayed cord clamping was not widely practiced.

A 2015 study from the neonatal intensive care unit (NICU) at the Baylor University Medical Center suggested that letting mom and her premature baby stay physically attached for few seconds longer could result in many benefits, including decreased incidence of brain bleeds, in this vulnerable population.

Since then, said Arpitha Chiruvolu, MD, FAAP, medical director of the neonatal intensive care unit at Baylor Scott & White Medical Center – McKinney and principal investigator of the study, further studies have established definite benefits of the practice of delayed cord clamping (or DCC).

“We published multiple papers showing that 60 seconds of delayed cord clamping is safe for all preterm infants,” Dr. Chiruvolu said. “Along with decreased incidence of intraventricular hemorrhage and the need for early blood transfusions, DCC was also associated with decreased incidence of respiratory distress syndrome and necrotizing enterocolitis in preterm infants. There was no increase in the incidence of hypothermia after birth or jaundice needing phototherapy.”

In the updated opinion published in 2017, the American College of Obstetricians and Gynecologists affirmed that delayed umbilical cord clamping “appears to be beneficial for term and preterm infants.” The ACOG recommends obstetricians wait at least 30 to 60 seconds after birth before cutting the umbilical cord for all newborns, unless circumstances indicate otherwise.

This is quite the opposite of what doctors used to think, once believing that immediate cutting of the cord would reduce the risk of maternal hemorrhage. Recent research by Dr. Chiruvolu showed that there was no increased risk of postpartum hemorrhage in the deliveries with delayed cord clamping.

The positive benefits of delayed cord clamping

In the original study, researchers reviewed 148 very preterm infants (less than 32 weeks’ gestation), which were a mix of historic and current patients at Baylor University Medical Center. When comparing babies who were immediately removed from the placenta and had the cord cut with those who had the 45-second delay, the effects of waiting were evident.

“We were impressed by the overall results, especially the significant reduction in intraventricular hemorrhage [bleeding in the brain] by almost 50 percent,” Dr. Chiruvolu said. “There were no adverse effects, and significantly fewer babies who got delayed cord clamping were intubated in the delivery room.”

During the first minute after childbirth, oxygen-rich blood from the placenta flows to the baby through the umbilical cord for the first few breaths. This blood also carries important nutrients, iron, stem cells and immunoglobulins.

Is delayed cord clamping the right move?

“We perform delayed cord clamping on all infants, preterm and term,” Dr. Chiruvolu said. “In preterm infants, delayed cord clamping is performed at least for 60 seconds. In term infants, delayed cord clamping is performed for longer duration when placed skin to skin on mother’s abdomen.”

It used to be believed that such delays could lead to neonatal jaundice needing phototherapy, but she said further studies have shown that is not the case.

“We published multiple papers on late preterm and term infants that delaying cord clamping for more than a minute is not associated with increased phototherapy for jaundice,” Dr. Chiruvolu said. “In these infants we delay cord clamping for at least a minute when held below the level of placenta or at least three minutes when placed on mom’s abdomen. We also perform cord milking in term infants during cesarean sections for better placental transfusion.”

Given the amount of research backing up the safety and benefits of delayed cord clamping, Baylor Scott & White subsequently updated its policies regarding cord clamping. All infants born get the cord clamping delayed unless there are rare circumstances.

A number of Dr. Chiruvolu’s research papers on delayed cord clamping are available on the National Library of Medicine’s PubMed site, including studies involving early late-preterm infants, the effects of delaying 45 seconds versus 60 seconds on preterm infants, and the effects of delayed clamping on very preterm twins.

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