How it works: Doctors wait to cut the cord.
He The American College of Obstetricians and Gynecologists already recommends delaying 30 to 60 second clamping for both full-term and preterm newborns.
Premature babies are those born before 37 weeks of gestation. In premature babies, delayed clamping improves circulation, reduces the need for blood transfusions, and reduces the incidence of serious complications, such as necrotizing enterocolitis or inflammation of the digestive tract.
The evidence on whether the practice is beneficial for them has been inconsistent, according to Anna Lene Seidler, lead author of two new review articles and a senior researcher at the University of Sydney in Australia.
The new research also sought to determine the optimal waiting time before clamping. The longest delays studied were three minutes after birth.
“We found that the longer we wait, the better and more we can reduce mortality,” Dr. Seidler said. “We were surprised by how consistent the findings are.”
Two new papers, published in The Lancet, analyzed dozens of studies involving thousands of babies born in hospitals in a variety of countries, including Britain, India, Iran and the United States.
The numbers: a two-minute delay seems optimal.
One of the reviews compared the effectiveness of three techniques: immediate cord clamping, delayed clamping, and milking an intact umbilical cord to allow more blood flow to the newborn.
The article examined 48 randomized trials and analyzed data from 6,367 babies, and found that delayed umbilical cord clamping reduced in-hospital deaths of premature newborns by a third, compared with immediate umbilical cord clamping. There were no statistically significant differences between other interventions.
A second review and meta-analysis, which included data from 47 trials with 6094 participants, compared umbilical cord milking with immediate clamping less than 45 seconds after birth, between 45 seconds and up to 120 seconds after birth, and two minutes or more after birth. .
The analysis found that longer deferral of restraint increased greater survival, compared to immediate clamping. But the authors noted that if the newborn needed immediate resuscitation, the umbilical cord should be kept intact only as long as resuscitation can be performed at the same time.
Why it’s important: Delayed clamping can be implemented quickly.
Around the world, about 13 million premature babies are born each year, and almost a million of them die within a month of birth. A low-cost, low-tech intervention, such as delayed umbilical cord clamping, has the potential to save many lives.
Premature births are a huge problem in the United States, where one in 10 babies is born prematurely. The rates are higher among black and Native American babies than among white and Hispanic babies.
Premature birth is a leading cause of death among American babies. Infant mortality rates rose last year for the first time in decades, according to the National Center for Health Statistics. Deaths are more common among black babies.
But implementing a change in guidelines to delay clamping the umbilical cord for two minutes or more can be difficult. Many premature babies in the United States are born by cesarean section and require resuscitation.
A delay could mean necessary equipment has to be brought to the operating room even though it must be kept in a sterile environment, such as a neonatal intensive care unit, said Dr. Anup Katheria, director of neonatal research at Sharp Mary Birch Women’s Hospital and New York. born in San Diego.
“I don’t think we know all the ramifications that a change in the guidelines could entail,” Dr. Katheria said. “But if it really reduces the risk of death, why would you cut the cord?”