The lives of thousands of preterm babies could be saved by waiting 60 seconds before clamping the umbilical cord after birth instead of clamping it immediately, a new systematic review of evidence has revealed.
To be published in the American Journal of Obstetrics and Gynecology, the review led by University of Sydney researchers, assessed morbidity and mortality outcomes from 18 trials comparing delayed versus immediate cord clamping in nearly 3,000 babies born before 37 weeks’ gestation. It found clear evidence that delayed clamping reduced hospital mortality by a third and is safe for mothers and pre-term infants.
The review also reported that delayed clamping reduced subsequent blood transfusions and increased neonatal hematocrit, confirming that placental transfusion occurred.
“This reports shows for the first time that simply clamping the cord 60 seconds after birth improves survival,” said the University of Sydney’s Professor William Tarnow-Mordi, senior author. “It confirms international guidelines recommending delayed clamping in all preterm babies who do not need immediate resuscitation.”
"We estimate that for every thousand preterm babies born ten weeks early, delayed clamping will save up to 100 additional lives compared with immediate clamping,” said the University of Sydney’s Associate Professor David Osborn, the review’s lead author and a neonatal specialist at Royal Prince Alfred Hospital. “This means that, worldwide, using delayed clamping instead of immediate clamping can be expected to save between 11,000 and 100,000 additional lives every year.”
The systematic review confirms new findings from the Australian Placental Transfusion Study, published in the New England Journal of Medicine, reporting that delayed clamping might reduce mortality at 36 weeks – tentative evidence that required confirmation by an updated review of all relevant trials.
The Australian Placental Transfusion Study enrolled 1,566 babies born over ten weeks early in 25 hospitals in seven countries. The authors reported a 6.4 percent mortality rate in the delayed clamping group compared to 9 percent mortality rate in the immediate clamping group (p=0.03 in unadjusted analyses; p=0.39 after post-hoc adjustment for multiple secondary outcomes).
The University of Sydney’s Professor Jonathan Morris, co-author of the Australian Placental Transfusion Study said: “This is so significant as it is such a simple technique, suitable for almost all preterm babies that helps saves lives”.
Parents who want to know more are encouraged to visit the NHMRC Clinical Trials Centre website at www.ctc.usyd.edu.au or Miracle Babies Foundation at www.miraclebabies.org.au for Frequently Asked Questions about the Australian Placental Transfusion Study. Parents in Australia who need support can contact Miracle Babies Foundation 24 hour helpline at 1300 622 243.
Co-author of the Australian Placental Transfusion Study, Professor Roger Soll of the University of Vermont College of Medicine, added “About 15 million babies are born before 37 weeks gestation annually and one million die. This procedure costs nothing and will make a difference to families worldwide."
These results were presented at the VON 2017 Annual Quality Congress, a gathering of the worldwide community of practice dedicated to improving the medical care of newborns where leading experts in neonatology and improvement science present about latest evidence and methods to implement evidence-based practices.
About Vermont Oxford Network
Vermont Oxford Network (VON) is a worldwide community of health care professionals dedicated improving the quality and safety of medical care for newborn infants and their families through a coordinated program of research, education, and quality improvement. Members use confidential information from the world’s largest and most comprehensive databases of high-risk infant data to benchmark their practices and outcomes and identify areas for improvement. Teams from around the world address critical and complex challenges of newborn care with evidence-based quality improvement methods guided by VON expert faculty and resources. www.vtoxford.org
Downloadable File: Delayed Clamping Study Results