Associate Professor of Neonatology, Division of Neonatology, Department of Pediatrics, Child Growth and Development Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
Assistant Professor of Obstetrics and Gynecology, Isfahan University of Medical Sciences, Isfahan, Iran.
Resident of Obstetrics and Gynecology, Medical Faculty, Isfahan University of Medical Sciences, Isfahan, Iran.
Associate Professor, Child Growth and Development Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
Background: The appropriate moment for clamping the umbilical cord is controversial. Immediate cord clamping (ICC) is an item of active management of the third stage of labor (AMTSL). Unclamped umbilical cord may cause inconvenience in preterm neonates because they commonly need some levels of emergent services. Some studies revealed delayed cord clamping (DCC) of preterm neonates results in better health conditions like lower rates of respiratory distress syndrome (RDS), less morbidities in labor room and lower risk of postpartum hemorrhage. The aim of the present study was to determine the effect of delayed umbilical cord clamping on premature neonatal outcomes.
Materials and Methods: In this single‑center randomized control trial study, sixty premature neonates (gestational age ≤ 34 weeks) were randomly assigned to ICC (cord clamped at 5–10 seconds) or DCC (30–45 seconds) groups and followed up in neonatal intensive care unit (NICU). Primary outcomes were 1st and 5th minute Apgar score, average of level of hematocrit after birth, intra ventricle hemorrhage and need some levels of resuscitation.
Results: Differences in demographic characteristics were not statistically significant. After birth, neonates who had delayed clamping had significantly higher mean hematocrit after at 4-hour of birth (49.58+5.15gr/dl vs. 46.58+5.40gr/dlin DCC vs. ICC groups, respectively) (P=0.031). Delayed cord clamping reduced the duration of need to nasal continues positive airway pressure (NCPAP) (86.7% and 60.0% in ICC and DCC groups, respectively, P= 0.039). Attractively, the results showed lower incidence of clinical sepsis in delayed cord clamping neonates (53.3% vs. 23.3% in ICC and DCC groups, respectively, P=0.033).
Conclusion: Prematurity complications might decrease by delay umbilical cord clamping which improve the hematocrit, duration of need to NCPAP and incidence of clinical sepsis. Furthermore, DCC may have no negative impact on neonatal resuscitation.