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    Delaying Umbilical Cord Clamping: A Lifesaving Practice

    How it operates: Physicians opt for a delayed cord clamping approach.

    The American College of Obstetricians and Gynecologists currently suggests postponing cord clamping by 30 to 60 seconds for both full-term and preterm infants.

    Preterm infants, those born before 37 weeks of gestation, experience improved circulation, reduced need for blood transfusions, and a lower incidence of severe complications like necrotizing enterocolitis (inflammation of the digestive tract) when cord clamping is delayed. However, the evidence regarding the practice’s benefits for full-term babies has been inconsistent, as pointed out by Anna Lene Seidler, the lead author of two recent review papers and a senior research fellow at the University of Sydney in Australia.

    The latest research also aimed to identify the optimal duration for delaying cord clamping, with the longest delays studied being three minutes after birth.

    “We discovered that the longer we delay, the better the outcomes, and the more we can reduce mortality,” remarked Dr. Seidler. “We were astonished by the consistency of the findings.”

    Two new papers, featured in The Lancet, analyzed numerous studies involving thousands of infants born in various countries, including Britain, India, Iran, and the United States.

    The Data: A two-minute delay appears most beneficial.

    One of the reviews compared the effectiveness of three techniques: immediate cord clamping, deferred clamping, and milking an intact umbilical cord to enhance blood flow to the newborn.

    This paper examined 48 randomized trials and scrutinized data from 6,367 infants. It revealed that delayed cord clamping reduced in-hospital deaths of preterm newborns by one-third compared to immediate cord clamping. No statistically significant differences were found with other interventions.

    A second review and meta-analysis, involving data from 47 trials with 6,094 participants, compared umbilical cord milking with clamping occurring less than 45 seconds after birth, between 45 seconds and up to 120 seconds after birth, and two minutes or more after birth.

    The analysis concluded that the longest delay in clamping had the most significant impact on survival compared to immediate clamping. Nevertheless, the authors emphasized that if the newborn required immediate resuscitation, the cord should remain intact only as long as resuscitation can be provided simultaneously.

    Why It’s Significant: Delayed clamping can be swiftly implemented.

    Globally, around 13 million premature babies are born each year, and nearly a million of them die within the first month of life. A cost-effective, low-tech intervention such as delayed cord clamping holds the potential to save numerous lives.

    Preterm births are a substantial concern in the United States, where one out of every ten infants is born prematurely. Rates are higher among Black and Native American infants compared to white and Hispanic infants.

    Preterm birth ranks as one of the leading causes of infant mortality in the United States. The National Center for Health Statistics reported an increase in infant mortality rates last year, the first in decades. This issue is more prevalent among Black infants.

    However, implementing a guideline change to delay umbilical cord clamping for two minutes or more may present challenges. Many preterm infants in the United States are delivered via cesarean section and require resuscitation.

    A delay in clamping could necessitate bringing essential equipment into the operating room, even though it should ideally be kept in a sterile environment like a neonatal intensive care unit, according to Dr. Anup Katheria, director of neonatal research at Sharp Mary Birch Hospital for Women & Newborns in San Diego.

    “I don’t think we fully understand the potential implications of a guideline change,” Dr. Katheria remarked. “But if it genuinely reduces the risk of death, why would you not delay cord clamping?”

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