Monday, June 20, 2005

Delayed Cord Clamping - benefits for preemies

Delayed cord clamping (30 seconds to 2 minutes after delivery) has been around for a while, but it hasn't been standard practice - at least not at my hospital - for preterm deliveries. That's changing thanks to some recent randomized trials on the subject. There have been several. They have different study criteria and slightly different outcomes. They all have one thing in common, though. There are benefits to delaying cord clamping for 45 seconds or longer, even when the baby is less than 30 weeks gestation.

45 seconds feels like a long time while you're waiting for the OB to hand over that preemie -- if you're used to the traditional quick clamp and immediate resuscitation. It was fascinating and a little scary to watch as the OB dried the baby, bulb suctioned his mouth, waited nearly a minute before clamping the cord and - unthinkable only a few weeks ago - offered the scissors to the father to cut the cord.

8 hours later, the admission nurse was still griping about the delay and the small study in Rhode Island found that "the DCC* group were more likely to have higher initial mean blood pressures and less likely to be discharged on oxygen. DCC group infants had higher initial glucose levels (*ICC=36 mg/dl, DCC=73.1 mg/dl; p=0.02)." and a meta-analysis of 7 studies found decreased need for transfusions and decreased incidence of intraventricular hemorrhage.

Risks? Apparently nothing significant was discovered over the course of several studies and hundreds of preterm births - both vaginal and C-section.

*DCC=Delayed Cord Clamping. ICC=Immediate Cord Clamping


Gypsybobocowgirl said...

Got your blog on my "next blog" button, and loved every minute of it. Excellently written, and good stories to tell. Keep it up and publish it.

Have you read the Echo Heron books? You would like them.

I hadn't heard about the cord blood--I will have to round in NICU and see what we are doing in our hospital.

Mary said...

Will be fascinating to see what you think of this after working with it for several months. Sounds hopeful!