Effects of delayed cord clamping on residual placental blood volume, hemoglobin and bilirubin levels in term infants: a randomized controlled trial

Abstract

Objective:

The objective of the study was to measure the effects of a 5-min delay (DCC) versus immediate cord clamping (ICC) on residual placental blood volume (RPBV) at birth, and hemoglobin and serum bilirubin at 24 to 48 h of age.

Study Design:

In this prospective randomized controlled trial, 73 women with term (37 to 41 weeks) singleton fetuses were randomized to DCC (5 min; n=37) or ICC (<20 s; n=36).

Results:

Maternal and infant demographics were not different between the groups. Mean cord clamping time was 303±121 (DCC) versus 23±59 (ICC) s (P<0.001) with 10 protocol violations. Cord milking was the proxy for DCC (n=11) when the provider could not wait. Infants randomized to DCC compared with ICC had significantly less RPBV (20.0 versus 30.8 ml kg−1, P<0.001), higher hemoglobin levels (19.4 versus 17.8 g dl−1, P=0.002) at 24 to 48 h, with no difference in bilirubin levels.

Conclusion:

Term infants had early hematological advantage of DCC without increases in hyperbilirubinemia or symptomatic polycythemia.

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Acknowledgements

This project was supported by the Bill and Melinda Gates Foundation, Grand Challenges Exploration, Phase I Grant, OPP1061070 and the NIH National Institute of Child Health & Human Development Grant 1R01HD076589. We would like to thank William Oh, MD and Betty Vohr, MD, for advising on the design of the study and Richard Tucker, BA for statistical consultation. We wish to thank the parents and infants who participated in this study and the research assistants and staff at Women and Infants Hospital. Without their trust and cooperation, this study would not have been possible.

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Correspondence to J S Mercer.

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Mercer, J., Erickson-Owens, D., Collins, J. et al. Effects of delayed cord clamping on residual placental blood volume, hemoglobin and bilirubin levels in term infants: a randomized controlled trial. J Perinatol 37, 260–264 (2017). https://doi.org/10.1038/jp.2016.222

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