Umbilical cord clamping could improve survival and reduces
risk of brain injury in extremely premature infants, according to the findings
of new research published in JAMA Network Open.
Over the years, emerging research has suggested there may be benefits to
delaying umbilical cord clamping in term neonates. However it was not clear if
this intervention would also have benefits on the survival of extremely low
gestational age preterm neonates.
In the new study, neonatologist Dr Abhay Lodha, MD, and his research team from
the Cumming School of Medicine at the University of Calgary found for the first
time that delaying umbilical cord clamping in extremely preterm babies improves
their survival. It also lowers the odds of severe neurological injury in the
form of an intraventricular haemorrhage.
“Delaying cord clamping allows time for the baby’s blood pressure to stabilise,”
says Lodha, associate professor in the departments of Paediatrics and Community
Health Sciences at the Cumming School of Medicine. “As premature babies’ brain
vessels are quite fragile, a rapid change in blood pressure can rupture their
blood vessels, causing a brain haemorrhage.”
In this retrospective cohort study, researchers analysed the outcomes of 4680
neonates across Canada who were born at 22 to 28 weeks and were admitted to a
neonatal intensive care units (NICU). The study suggests deferred umbilical
cord clamping (DCC) leads to circulatory stability, which improves blood
pressure and reduces the need for transfusions.
The researchers also found DCC reduced the risk of infection by allowing the
newborn to receive more nutrient- and immune cell-rich blood from the mother.
“As long as the baby is stable at the time of birth, we recommend delaying
umbilical cord clamping for 30 to 60 seconds,” says Lodha. “This is a simple
intervention that could reduce the need for medication to treat hypotension,
reduce the risk of infections, and improves the baby’s survival. We hope this
new information will have a global impact, especially in developing countries,
and save many premature neonates.”
A, et al. Association of Deferred vs Immediate Cord Clamping With Severe
Neurological Injury and Survival in Extremely Low-Gestational-Age Neonates. JAMA Netw Open. Published 29 March 2019.