A new study says delaying clamping reduces a child’s relative risk of death or serious disability in early childhood by 17% and up to 30% before the age of two.
The new study, led by the University of Sydney, is a two-year continuation of the Australian Placental Transfusion Study, an award-winning and largest-ever clinical trial of delayed cord clamping in babies born before 30 weeks. It was carried out in 25 hospitals spread across seven nations.
The current study examined the results of nearly 1500 newborns from the original trial, 767 with caregivers aiming for a 60-second delay in cord clamping and 764 with caregivers aiming for cord clamping within 10 seconds of delivery.
Delaying clamping reduces a child’s relative risk of death or serious disability in early childhood by 17%, according to the researchers. This included a 30% drop in mortality before the age of two.
Furthermore, the delayed-clamping group had 15% fewer infants who required blood transfusions after birth.
It is coordinated by the University of Sydney’s NHMRC Clinical Trials Centre in partnership with the Perinatal Society of Australia and New Zealand’s IMPACT Clinical Trials Network and the Australian and New Zealand Neonatal Network.
Professor William Tarnow-Mordi, Head of Neonatal and Perinatal Trials at the Clinical Trials Centre and Professor of Neonatal Medicine in the Faculty of Medicine and Health, who led the study, stated that the simple technique of waiting a minute before clamping will have a global impact.
“It’s very rare to find an intervention with this sort of impact that is free and requires nothing more sophisticated than a clock. This could significantly contribute to the UN’s Sustainable Development goal to end preventable deaths in newborns and children under five – a goal which has really suffered during the pandemic,” Professor said.
“Applied consistently worldwide, aiming to wait a minute before cord clamping in very preterm babies who do not require immediate resuscitation could ensure that an extra 50,000 survive without major disability in the next decade,” added biostatistician Dr Kristy Robledo who led the two-year follow-up analysis.
“In other words, for every 20 very preterm babies who get delayed instead of immediate clamping, one more will survive without major disability.”
Why delay umbilical cord clamping?
Delayed umbilical cord clamping is common in full-term babies to give the newborn time to adjust to life outside the womb; but, until recently, clinicians cut the cord of preterm babies quickly so that urgent medical care could be provided.
“Ten years ago, umbilical cords were routinely clamped quickly after a very preterm birth and the baby was passed to a paediatrician in case the child needed urgent help with breathing,” added Professor Tarnow-Mordi.
“But we now know that almost all very preterm babies will start breathing by themselves in the first minute, if they are given that time.”
“We think that, after delaying cord clamping, babies get extra red and white blood cells and stem cells from the placenta, helping to achieve healthy oxygen levels, control infection and repair injured tissue.”
What does this entail for the newborns of today?
The Australian Placental Transfusion Study’s childhood follow-up is the world’s largest two-year follow-up of preterm cord clamping, providing the best evidence to date on beneficial outcomes at two years of age.
Melinda Cruz, co-author and founder of the Miracle Babies Foundation and a mother of three preterm babies, said she hoped the findings would give parents the confidence to discuss their options with their birthing professionals.
“I hope that prospective parents around the world will read about this trial for themselves and discuss it with their midwives and obstetricians,” she added.
“Moving forward it’s vital that perinatal professionals record the time of first breath and cord clamping to the second during births to allow for robust, large-scale data to further our work in this area,” said co-author Professor Jonathan Morris.
“Intensive staff training in the new protocols will also be vital as it can be daunting to delay treatment in very early and sick babies, but the evidence suggests this results in the best outcomes for these children.”
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