There are benefits and risks to delayed cord clamping and our student, Amanda, has done a great job of outlining both sides. It’s important to know both benefits and risks when making an informed decision.
BENEFITS OF DELAYED CORD CLAMPING (DCC):
- Boost in Neurodevelopment – Just a three-minute delay in clamping the cord can allow one-half of a cup of blood or more to return to the baby’s system. While that may not seem like much, current research suggests that it has significant neurological impacts even years down the road. Children who experienced delayed cord cutting were found to have slightly elevated social skills and fine motor skills compared to their peers who had cords cut within 10 seconds of birth. However, it is important to note that these findings only applied to boys.
- Reduced Anemia – Iron is one of the essential building blocks of life. Among other things, it is essential for healthy brain development in babies. The natural exchange of blood via delayed clamping provides a significant amount of additional iron to the baby. One study found that a delay of even two minutes increased overall iron stores by 27-47 mg.
- Smoother Cardiopulmonary Transition – Whether premature or full term, babies come into this world with roughly one-third of their blood stored in the placenta. This amount is equivalent to that needed to fully supply the baby’s lungs, kidneys and liver. That said, babies whose cords are clamped at the two or three-minute mark have an increased total blood volume and typically experience a smoother cardiopulmonary transition at birth. Delayed clamping may also ensure that the child receives all of the important clotting factors at birth.
- Increased Stem Cell Stores – Delaying clamping by even one or two minutes has an impressive impact on stem cells in the child’s body. These cells play a role in the development of the body’s systems including the immune, respiratory, cardiovascular and central nervous systems. If the cord is clamped immediately, roughly one-third of the baby’s available stem cells remain in the placenta.
- Improved Outcomes for Premature Infants – The benefits of delayed clamping extend beyond just full term births. In fact, preemies who have delayed clamping tend to have better outcomes across the board: better blood pressure, less need of drugs, fewer transfusion and less bleeding in the brain.
RISKS OF DELAYED CORD CLAMPING (DCC):
- Hyperbilirubinemia – Occurs when bilirubin levels build up too much in the blood. Bilirubin results from a breakdown of red blood cells. In the womb, the placenta takes care of the excess bilirubin, but after birth, the baby’s liver must process the bilirubin on its own. It is hypothesized that DCC babies will have a greater incidence of hyperbilirubinemia due to increased iron stores.
However, other reports have found there is no significant difference in mean serum bilirubin levels between ICC and DCC infants, meaning there is no increased risk of jaundice in DCC babies.
- Polycythemia –Occurs when there is an excess of red blood cells in circulation. When there is excess blood flow to the newborn, the development of blood hyperviscosity (increased thickness) can be a concern. However, a Cochrane meta-analysis found that DCC infants are not exposed to an increased risk of developing polycythemia. More research is needed to determine with certainty whether DCC has a hand in newborns developing polycythemia.
- Respiratory distress – Occurs when there is not enough of a liquid coating in the lungs (surfactant) after birth to keep the airways and tiny alveoli of the lungs open. This can cause a buildup of damaged cells near the lungs and a buildup of carbon dioxide in the blood. When this happens, babies often need to be placed on a ventilator. It is suggested that the delayed absorption of lung fluid due to the increase in blood volume may cause transient tachypnea (rapid breathing). A Cochrane review found a similar number of DCC and ICC infants were admitted with respiratory distress, which suggests DCC babies are no more at risk than ICC infants. If an infant is in respiratory distress during delivery, DCC can delay resuscitation efforts. However, DCC will not be performed in these circumstances, and ICC will be adopted instead.
- Postpartum Hemorrhage – There are also concerns around whether or not DCC increases maternal risk of hemorrhage. However, there is no statistical evidence proving that DCC results in an increase in blood loss. There is also no significant difference regarding blood loss greater than 500ml between early and delayed cord clamping.