Maternal and Neonatal effects of Delayed Cord Clamping: A Systematic Review and Meta-analysis

Background: The practice of delayed cord clamping (DCC), is recommended by many international organizations or guidelines, such as WHO, ACOG , with a view to improve maternal and infant health and nutrition outcomes. DCC is recommended for both vigorous term and preterm newborns for at least 30 to 60 seconds. Many evidence indicates that DCC is beneficial in terms of improved hematological status (hematocrit, hemoglobin concentration, anemia rate and transfusion requirement for anemia), better iron status (ferritin concentration and stored iron), lower risk for necrotising enterocolitis, reduced overall mortality, less intraventricular hemorrhage, decreased blood transfusion incidence, reduced episodes of late-onset sepsis and better blood pressure in short term, especially within the first week after birth. Given the current available meta analyses, we evaluated the effects of DCC on mothers and infants in order to narrow this knowledge gap and gain a more comprehensive view of this issue.Method: The literature search was done by searching the Cochrane, PubMed, EMBASE, ongoing clinical trials and abstract of conferences from January 2013 to February 2019.Results :In a Cochrane review of full-term newborns who have received DCC, there were no statistically significant differences in mortality rate, Apgar score, or admission to a neonatal intensive care unit. DCC in term infants, increases haemoglobin and ferritin for the first months of life, with possible neurodevelopmental benefit later in life. Jaundice requiring phototherapy is increased if delayed clamping is practiced, therefore phototherapy equipment should be available. DCC at birth can support the preterm newborn during the transition to extrauterine life through an autologous transfusion of blood from the placenta to the newborn. This intervention has been found to result in fewer transfusions for anemia, a decreased incidence of intraventricular hemorrhage, and a decreased incidence of necrotizing enterocolitis. DCC was not associated with an increased risk of postpartum hemorrhage or increased blood loss at delivery, nor was it associated with a difference in postpartum hemoglobin levels or the need for blood transfusion.Conclusion: Delayed cord clamping for about 30-60 seconds seem to be beneficial for both term and preterm infants, and should be recommended, except in the presence of neonatal or maternal indications that require immediate cord clamping.

Keywords:

Delayed Cord Clamping , Time , Newborns