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Review
. 2022 Apr 1;34(2):170-177.
doi: 10.1097/MOP.0000000000001117.

Toward greater nuance in delayed cord clamping

Laura Marrs  1 , Susan Niermeyer  2
Affiliations
Review

Toward greater nuance in delayed cord clamping

Laura Marrs et al. Curr Opin Pediatr. .

Abstract

Purpose of review: For over a decade, the International Liaison Committee on Resuscitation has recommended delayed cord clamping (DCC), but implementation has been variable due to lack of consensus on details of technique and concerns for risks in certain patient populations. This review summarizes recent literature on the benefits and risks of DCC in term and preterm infants and examines alternative approaches such as physiologic-based cord clamping or intact cord resuscitation (ICR) and umbilical cord milking (UCM).

Recent findings: DCC improves hemoglobin/hematocrit among term infants and may promote improved neurodevelopment. In preterms, DCC improves survival compared to early cord clamping; however, UCM has been associated with severe intraventricular hemorrhage in extremely preterm infants. Infants of COVID-19 positive mothers, growth-restricted babies, multiples, and some infants with cardiopulmonary anomalies can also benefit from DCC. Large randomized trials of ICR will clarify safety and benefits in nonvigorous neonates. These have the potential to dramatically change the sequence of events during neonatal resuscitation.

Summary: Umbilical cord management has moved beyond simple time-based comparisons to nuances of technique and application in vulnerable sub-populations. Ongoing research highlights the importance of an individualized approach that recognizes the physiologic equilibrium when ventilation is established before cord clamping.

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Figures

Figure 1
Figure 1
Forest Plot of DCC vs ECC demonstrating survival to hospital discharge Reprinted with permission from Seidler AL, Gyte GML, Rabe H, Diaz-Rossello JL, Duley L, Aziz K, et al. Umbilical cord management for newborns < 34 weeks’ gestation: a meta-analysis. Pediatrics 2021;147(3).
Figure 2
Figure 2
Example of resuscitation team and equipment locations during an ICR trial for (A) vaginal delivery and (B) caesarean section. The referenced pole was mobile and contained a T-piece resuscitator. Reprinted with permission from Foglia EE, Ades A, Hedrick HL, Rintoul N, Munson DA, Moldenhauer J, et al. Initiating resuscitation before umbilical cord clamping in infants with congenital diaphragmatic hernia: a pilot feasibility trial. Arch Dis Child Fetal Neonatal Ed. 2020; 105(3):322–6.
See this image and copyright information in PMC

References

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    1. Gomersall J, Berber S, Middleton P, McDonald SJ, Niermeyer S, El-Naggar W, et al. Umbilical Cord Management at Term and Late Preterm Birth: A Meta-analysis. Pediatrics 2021;147(3).

      *Cochrane systematic review and meta-analysis comparing the range of approaches to umbilical cord management in term and near-term infants