Reducing Risk for Premature Babies: Delayed Cord Clamping and Cord Milking Techniques

2023-12-14 20:58:20

2 techniques are practiced and documented to promote health outcomes in premature babies:

• cord clamping which is the standard procedure: the procedure takes between 30 and 180 seconds, and gives time for the blood to circulate in the body and for the infant’s lungs to fill with air;
• cord milking which takes approximately 20 seconds, reducing the delay for infants who need immediate assistance, such as respiratory assistance. This second technique has just been documented as safe for premature babies born following 28 weeks of pregnancy, by a study published in the journal Pediatrics.

Both procedures aim to reduce the risk of anemia and other complications.

Delaying clamping sufficiently can cut risk of death in half

Worldwide, nearly 13 million babies are born prematurely each year and, sadly, nearly 1 million die shortly following birth. “It is therefore crucial to document procedures that might help save the lives of these premature babies,” says lead author Dr Anna Lene Seidler from the University of Sydney.

Delayed cord clamping is now common practice, also recommended for full-term babies. However, although previous research has shown benefits for premature babies, best practices for this vulnerable group remain unclear. Until recently, doctors typically cut premature babies’ cords immediately so they might provide urgent care. Finally, guidelines differ depending on the case: the World Health Organization and the British Health Institute NICE recommend delaying umbilical cord clamping for at least 1 minute following birth to improve the health and nutrition of the mother and child. infant, but for premature babies requiring resuscitation, immediate clamping is recommended.

These 2 additional analyzes examine data from clinical trials and thousands of premature babies who benefited from this delayed cord clamping procedure vs. other premature babies whose cords were clamped immediately following birth. These studies reveal that waiting 2 minutes to clamp the umbilical cord of a premature baby might help significantly reduce the risk of death, compared to immediate clamping of the umbilical cord or a shorter wait before clamping. The analysis therefore covers data from more than 60 studies including more than 9,000 babies.

The first studycarried out on data from 3,292 infants reveals that:

• delayed clamping of the umbilical cord, 30 seconds or more following birth, reduces the risk of death in premature babies by a third compared to immediate clamping;
• Analysis of data from a subgroup of premature babies born before 32 weeks of gestation revealed that 45% of babies who underwent immediate cord clamping suffered from hypothermia following birth vs. 51% of those who underwent cord clamping. delayed clamping; These data call for particular care to be taken to keep premature babies warm when postponing umbilical cord clamping.

The second study covers data from 47 clinical trials including 6,094 babies and notes that:

• waiting at least 2 minutes before clamping can reduce the risk of death vs. waiting less;
• waiting at least 2 minutes before clamping is 91% the best protocol to prevent the risk of death shortly following birth;
• immediate clamping, on the other hand, has “very little chance”: 1% or less of being the best treatment to prevent the risk of death.

This new analysis concludes that immediate clamping is no longer necessary and, instead, available evidence suggests delaying cord clamping for at least 2 minutes.

However, the researchers highlight clinical situations where further research is still needed particularly when babies need immediate resuscitation.

The team is already working with international health agencies to revise the guidelines and recalls a basic principle: premature birth requires above all the intervention of a multidisciplinary team.

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