Waiting for two minutes or longer to clamp the umbilical cord of a premature baby likely reduces the risk of death soon after birth, compared with immediately clamping the cord or waiting a shorter time, according to two studies published in The Lancet.
In a groundbreaking revelation, two companion systematic reviews and meta-analyses studies suggest that waiting for two minutes or longer before clamping the umbilical cord of premature babies can significantly reduce the risk of death soon after birth.
The findings provide the most comprehensive analysis to date, challenging previous uncertainties about the practice’s benefits for premature infants.
“Worldwide, almost 13 million babies are born prematurely each year, and sadly, close to 1 million die shortly after birth. Our new findings are the best evidence to date that waiting to clamp the umbilical cord can save the lives of some premature babies,” says Dr. Anna Lene Seidler at the NHMRC Clinical Trials Centre, University of Sydney.
The researchers conducted an extensive systematic review, incorporating data from over 60 studies with more than 10,000 premature babies. The meta-analysis comparing deferred versus immediate umbilical cord clamping in 3,292 babies revealed a significant reduction in mortality risk for those with delayed clamping. Specifically, 6.0% of babies with deferred clamping died compared to 8.2% with immediate clamping, equating to a one-third reduction in risk.
In a subgroup analysis for babies born before 32 weeks of pregnancy, deferred cord clamping also showed benefits, with a lower incidence of hypothermia compared to immediate clamping. However, researchers emphasized the importance of keeping premature babies warm when deferring clamping.
Prof. Lisa Askie, senior author of the study, notes, “Our findings highlight that particular care should be taken to keep premature babies warm when deferring umbilical cord clamping. This could be done by drying and wrapping the baby with the cord intact, and then by placing the dry baby directly on the mother’s bare chest under a blanket or using bedside warming trollies.”
The second network meta-analysis, encompassing 47 trials with 6,094 infants, demonstrated that waiting at least two minutes before clamping the cord reduced the risk of death in premature babies by two-thirds compared to immediate clamping. The statistical analysis indicated a 91% probability that waiting two or more minutes is the best treatment to prevent death shortly after birth.
Until recently, it was standard practice to clamp the umbilical cord immediately after birth for premature babies so they could be dried, wrapped, and if necessary, resuscitated with ease.
Dr. Sol Libesman, lead statistician for the study, underscores the shift in standard practice, stating, “Our study shows that there is no longer a case for immediate clamping, and instead, presently available evidence suggests that deferring cord clamping for at least two minutes is likely the best cord management strategy to reduce the risk of premature babies dying shortly after birth.”
While implementation into practice requires consideration of various factors, the authors stress the importance of further research into providing immediate care to the sickest premature babies while keeping the cord intact. They suggest that with appropriate training, equipment, and a collaborative approach involving midwives, doctors, and parents, deferring cord clamping can be successfully integrated into care practices for healthier premature babies.
ends