A simple way to save premature babies
How it works: Doctors wait to cut the cord.
The The American College of Obstetricians and Gynecologists already recommends a postponement clamps with 30 to 60 seconds for both full-term and preterm newborns.
Premature babies are babies born before the 37th week of pregnancy. In premature infants, delayed clamping leads to better circulation, less need for blood transfusions and a lower incidence of serious complications, such as necrotizing enterocolitis or inflammation of the digestive tract.
The evidence on whether the practice is beneficial for them is inconsistent, according to Anna Lene Seidler, lead author of two new review articles and senior research fellow at the University of Sydney in Australia.
The new research also attempted to determine the optimal waiting time for clamping. The longest delays studied were three minutes after birth.
“We found that the longer we wait, the better, and the more we can reduce mortality,” said Dr. Seidler. “We were surprised at how consistent the findings are.”
Two new papers published in The Lancet analyzed dozens of studies involving thousands of babies born in hospitals in several countries, including Britain, India, Iran and the United States.
The numbers: A two-minute delay seems optimal.
One of the reviews compared effectiveness consists of three techniques: immediate clamping of the umbilical cord, delayed clamping and milking of an intact umbilical cord so that more blood flows to the newborn.
The paper examined 48 randomized trials and analyzed data from 6,367 infants, finding that delayed umbilical cord clamping reduced deaths among hospitalized 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 studies with 6,094 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 the longest delay in clamping increased survival the most, compared to immediate clamping. But the authors noted that if the newborn required immediate resuscitation, the umbilical cord should only be left intact as long as resuscitation could take place at the same time.
Why it’s important: Delayed clamping can be implemented quickly.
Worldwide, around 13 million premature babies are born every year, and almost a million of them die within a month of birth. A cheap, low-tech intervention such as delayed cord clamping has the potential to save many lives.
Preterm birth is a huge problem in the United States, where one in ten children are born prematurely. The rates are higher among black and Native American babies than among white and Hispanic babies.
Preterm birth is one of the leading causes of death among American infants. According to the National Center for Health Statistics, infant mortality rose last year for the first time in decades. Deaths are more common among black babies.
But implementing a change in guidelines to delay umbilical cord clamping for two minutes or more can be complicated. Many premature babies in the United States are born by cesarean section and require resuscitation.
A delay could mean bringing needed equipment to the operating room, even if it needs to 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 Hospital for Women and Newborns in San Diego.
“I don’t think we know the full implications that a change in guidelines could bring,” said Dr. Catherine. “But if it really reduces the risk of death, why cut the cord?”