Delayed Umbilical Cord Clamping in Premature Neonates

Kaempf, Joseph W. MD; Tomlinson, Mark W. MD; Kaempf, Andrew J. BS; Wu, YingXing MD; Wang, Lian MS; Tipping, Nicole RN; Grunkemeier, Gary PhD

doi: 10.1097/AOG.0b013e31825f269f
Original Research

OBJECTIVE: Delayed umbilical cord clamping is reported to increase neonatal blood volume. We estimated the clinical outcomes in premature neonates who had delayed umbilical cord clamping compared with a similar group who had early umbilical cord clamping.

METHODS: This was a before–after investigation comparing early umbilical cord clamping with delayed umbilical cord clamping (45 seconds) in two groups of singleton neonates, very low birth weight (VLBW) (401–1,500 g) and low birth weight (LBW) (greater than 1,500 g but less than 35 weeks gestation). Neonates were excluded from delayed umbilical cord clamping if they needed immediate major resuscitation. Primary outcomes were provision of delivery room resuscitation, hematocrit, red cell transfusions, and the principle Vermont Oxford Network outcomes.

RESULTS: In VLBW neonates (77 delayed umbilical cord clamping, birth weight [mean±standard deviation] 1,099±266 g; 77 early umbilical cord clamping 1,058±289 g), delayed umbilical cord clamping was associated with less delivery room resuscitation, higher Apgar scores at 1 minute, and higher hematocrit. Delayed umbilical cord clamping was not associated with significant differences in the overall transfusion rate, peak bilirubin, any of the principle Vermont Oxford Network outcomes, or mortality. In LBW neonates (172 delayed umbilical cord clamping, birth weight [mean±standard deviation] 2,159±384 g; 172 early umbilical cord clamping 2,203±447 g), delayed umbilical cord clamping was associated with higher hematocrit and was not associated with a change in delivery room resuscitation or Apgar scores or with changes in the transfusion rate or peak bilirubin. Regression analysis showed increasing gestational age and birth weight and delayed umbilical cord clamping were the best predictors of higher hematocrit and less delivery room resuscitation.

CONCLUSION: Delayed umbilical cord clamping can safely be performed in singleton premature neonates and is associated with a higher hematocrit, less delivery room resuscitation, and no significant changes in neonatal morbidities.

LEVEL OF EVIDENCE: II

Delaying umbilical cord clamping for 45 seconds increases the hematocrit in singleton premature neonates and appears both feasible and safe.

From the Departments of Neonatology and Obstetrics, Providence St. Vincent Medical Center, Portland, Oregon.

Supported by the Vollum Family Foundation and Northwest Newborn Specialists PC.

Corresponding author: Joseph W. Kaempf, MD, Providence St Vincent Medical Center, Departments of Neonatology and Obstetrics, 9205 SW Barnes Road Portland, OR 97225; e-mail: joe@nnspc.com.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2012 The American College of Obstetricians and Gynecologists