Delay in cutting umbilical cord good for babies

19 August, 2007:

A delay in cutting the umbilical cord could improve a newborn’s health. A newborn’s umbilical cord is usually clamped and cut within a minute of birth to counter the risk of jaundice.

But waiting until three minutes would increase the child’s iron levels and reduce the risk of anemia, says Dr Andrew Weeks, a senior lecturer in obstetrics at University of Liverpool’s School of Reproductive and Developmental Medicine, the United Kingdom.

A research conducted in the United States earlier had found that such a delay was most beneficial to premature babies and had no impact on rates of jaundice.

Dr Weeks’ study – which is an overview of trials involving 1,900 newborns – showed that delayed clamping of the umbilical cord only failed to benefit babies whose growth had been restricted.

The rate of early cord-cutting varies around Europe. In Denmark, the figure is only 17%, compared with 75% in Britain, and 90% in France.

Dr Weeks told the British Medical Journal that a delay in cutting the cord helped more oxygen-rich blood reach the baby’s lungs. This increases iron
levels until the newborn’s own breathing can become fully established.

The umbilical cord is important for the baby at birth since it sends oxygen-rich blood to the lungs until the infant’s breathing establishes.

Therefore, as long as the cord is unclamped, the average transfusion to the newborn is equivalent to 21% of the neonate’s final blood volume and three quarters of the transfusion occurs in the first minute after birth.

For babies born at term, large autotransfusion can increase their iron status. This may be lifesaving in areas where anemia is endemic.

Though in developed countries, there is the worry that delayed clamping and cutting of the cord increase the risk of polycythaemia and perbilirubinaemia (abnormally high levels of red blood cells and bile pigments in the bloodstream, often leading to jaundice), trials have show this is not the case.

Dr Weeks explains: “In normal deliveries, delaying cord-clamping for three minutes with the baby on the mother's abdomen should not be difficult. The
situation is a little more complex for babies born by caesarean section, or for those who need support soon after birth. Nevertheless, it is these babies
who may benefit most from a delay in cord-clamping.”

There is now considerable evidence that early cord-clamping does not benefit mothers or babies and may even be harmful, he said.

The World Health Organisation (WHO) no longer advocates early cord-cutting. According to the Royal College of Obstetricians and Gynaecologists, there are no guidelines in this regard in the United Kingdom.

Dr Andrew Weeks’ comments in the British Medical Journal came after a study published earlier in 2007 in the Journal of the American Medical Association which claimed that a delay of at least two minutes in cutting the cord could help the baby by boosting iron levels.

Another study conducted in the United States has shown that delaying clamping reduced hemorrhaging in the brain of premature babies by 62%.