Brian Brocato1, Nicolette Holliday1, Richard M Whitehurst2, David Lewis3, Stephen Varner1. 1. Assistant Professor, Department of Obstetrics and Gynecology. 2. Associate Professor, Department of Pediatrics. 3. Professor and Chair, Department of Obstetrics and Gynecology, University of South Alabama, Mobile, AL.
Abstract
IMPORTANCE: Delayed clamping of the umbilical cord of premature neonates decreases perinatal morbidity. Allowing time for autotransfusion of placental blood before the umbilical cord is clamped represents a simple practice that may have significant impact. In light of many professional societies recommending delayed cord clamping in premature neonates because of its beneficial effects, the topic still holds many unanswered questions. OBJECTIVE: The purpose of this article is to review the most recent evidence available regarding delayed cord clamping in premature neonates. EVIDENCE ACQUISITION: A literature search using PubMed, Cochrane database, and cumulative index of nursing and allied health literature provided the references for this review. RESULTS: Although the evidence comes primarily from small trials, delayed umbilical cord clamping in premature neonates is associated with less need for red blood cell transfusions, increase in hemoglobin and hematocrit levels, and decrease in risk of intraventricular hemorrhage and necrotizing enterocolitis. No maternal or neonatal risks have been demonstrated. Data on long-term outcomes are lacking. CONCLUSIONS AND RELEVANCE: Delayed cord clamping in premature neonates is a simple procedure that the current evidence supports to improve neonatal morbidity. The impact on long-term outcomes remains limited. The optimal time to delay cord clamping and potential risks are poorly studied.
IMPORTANCE: Delayed clamping of the umbilical cord of premature neonates decreases perinatal morbidity. Allowing time for autotransfusion of placental blood before the umbilical cord is clamped represents a simple practice that may have significant impact. In light of many professional societies recommending delayed cord clamping in premature neonates because of its beneficial effects, the topic still holds many unanswered questions. OBJECTIVE: The purpose of this article is to review the most recent evidence available regarding delayed cord clamping in premature neonates. EVIDENCE ACQUISITION: A literature search using PubMed, Cochrane database, and cumulative index of nursing and allied health literature provided the references for this review. RESULTS: Although the evidence comes primarily from small trials, delayed umbilical cord clamping in premature neonates is associated with less need for red blood cell transfusions, increase in hemoglobin and hematocrit levels, and decrease in risk of intraventricular hemorrhage and necrotizing enterocolitis. No maternal or neonatal risks have been demonstrated. Data on long-term outcomes are lacking. CONCLUSIONS AND RELEVANCE: Delayed cord clamping in premature neonates is a simple procedure that the current evidence supports to improve neonatal morbidity. The impact on long-term outcomes remains limited. The optimal time to delay cord clamping and potential risks are poorly studied.