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Association of a Delayed Cord-Clamping Protocol With Hyperbilirubinemia in Term Neonates

Yang, Sophia, MD, MS; Duffy, Jennifer Y., MD, MHS; Johnston, Robert, MD; Fall, Carolyn, MD; Fitzmaurice, Laura E., MD

doi: 10.1097/AOG.0000000000003172
Contents: Labor: Original Research

OBJECTIVE: To evaluate the implementation of a delayed cord-clamping protocol at an academic medical center, and its short-term associations on term neonates.

METHODS: This was a retrospective cohort study of women aged 18 years or older delivering a term neonate at an academic medical center before and 5–7 months after implementation of a universal delayed cord-clamping protocol (October–December 2015 and October–December 2016, respectively). The primary outcome measure was the mean peak neonatal transcutaneous bilirubin level, with secondary outcome measures including mean initial transcutaneous bilirubin levels, mean serum bilirubin levels, number of serum bilirubin levels drawn, incidence of clinical jaundice, and phototherapy.

RESULTS: Protocol adherence was 87.8%. Data are presented on 424 neonates. The mean peak neonatal transcutaneous bilirubin levels were significantly higher among neonates in the postprotocol group (10.0±3.4 mg/dL vs 8.4±2.7 mg/dL, P<.01). More neonates in the postprotocol group were diagnosed with jaundice (27.2% vs 16.6%; odds ratio [OR] 1.88; 95% CI 1.17–3.01) and required serum blood draws (43.7% vs 29.4%; OR 1.86; 95% CI 1.25–2.78). However, there were no differences in mean peak serum bilirubin levels between groups (9.7±3.0 mg/dL vs 9.1±3.1 mg/dL, P=.17) or need for phototherapy (5.2% vs 6.6%, OR 1.28; 95% CI 0.57–2.89).

CONCLUSION: Implementation of a delayed cord-clamping protocol for term neonates was associated with significantly higher mean transcutaneous bilirubin levels, an increased number of serum blood draws, and more clinical diagnoses of jaundice, although there was no increase in the incidence of phototherapy.

Delayed cord-clamping protocol was associated with higher transcutaneous bilirubin levels, more blood draws, and jaundice in term neonates.

University of California, Irvine, School of Medicine, Irvine, and the Department of Obstetrics and Gynecology, University of California, Irvine, Orange, California.

Corresponding author: Laura E. Fitzmaurice, MD, University of California, Irvine, School of Medicine, Obstetrics and Gynecology, 333 City Blvd West, Suite 1400, Orange, CA 92868; email:

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

Each author has confirmed compliance with the journal's requirements for authorship.

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© 2019 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.