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Impact of Delayed Cord Clamping

Delayed Cord Clamping (DCC) is beneficial for infants

Delayed cord clamping (DCC) is the practice of delaying the clamping of the umbilical cord for 1 – 3 minutes once the baby is delivered. Blood flows from the umbilical cord and placenta to the baby increases the iron and hemoglobin levels which has beneficial outcomes for babies.
A number of studies have demonstrated that delayed cord clamping resulted in improved iron status and reduced prevalence of iron deficiency at 4 months of age in infants. As a result, World Health Organization (WHO) has issued an international guideline to delay cord clamping by at least one minute.
In the United States, the American College of Obstetricians and Gynecologists (ACOG) has issued an opinion stating that clamping should be delayed 30-60 seconds.

At least 3 out of 4 cord blood units fail to meet public cord blood banking TNC thresholds* after DCC for >60 seconds

However, cord blood stem cell counts are found to be reduced significantly following delayed cord clamping . A study done by Allan et al. (2016) found that the 50.5 percent (50/99) of cord blood units have at least 1.25 billion TNCs** without DCC performed (Figure 1, green). The proportion of cord blood units reaching that number decreased by more than half to 24.5 percent (24/98), slightly more than three quarters of the total units, following DCC of more than 60 seconds (Figure 1, red).

Impact of DCC on percentage of cord blood units collected that has at least 1.25 billion TNCs per unit

Figure 1. Delayed clamping of >60 seconds reduces the proportion of cord blood units with >1.25 billion TNC count by more than 50%compared with no clamping.
*Assuming that the average public cord blood bank’s minimum TNC threshold is 1.25 billion TNCs
**Total Nucleated Cells

References

  1. American College of Obstetricians and Gynecologists (2017). Committee Opinion No. 684 – Delayed umbilical cord clamping after birth. Obstet Gynecol, 129, 5–10. https://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Delayed-Umbilical-Cord-Clamping-After-Birth
  2. Hutton, E. K.& Hassan, E. S. (2007). Late vs Early Clamping of the Umbilical Cord in Full-term Neonates Systematic Review and Meta-analysis of Controlled Trials. JAMA, 297(11), 1241–1252. https://jamanetwork.com/journals/jama/article-abstract/206143
  3. McDonald, S. J.& Middleton, P. (2008). Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. Cochrane Database of Systematic Reviews, Issue 2. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004074.pub2/epdf
  4. Cernadas, J. M. C. et al. (2006). The Effect of Timing of Cord Clamping on Neonatal Venous Hematocrit Values and Clinical Outcome at Term: A Randomized, Controlled Trial. Pediatrics, 117(4), e779-e786. http://pediatrics.aappublications.org/content/117/4/e779.short
  5. Geneva: World Health Organization (2014). Guideline: Delayed Umbilical Cord Clamping for Improved Maternal and Infant Health and Nutrition Outcomes. http://apps.who.int/iris/bitstream/10665/148793/1/9789241508209_eng.pdf?ua=1
  6. Allan, D. S. et al. (2016). Delayed clamping of the umbilical cord after delivery and implications for public cord blood banking. Transfusion, 56, 662–665. https://www.ncbi.nlm.nih.gov/pubmed/26585667