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



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).


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.


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

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.

Figure 1


  1. 1

    ACOG. Committee Opinion No.543: timing of umbilical cord clamping after birth. Obstet Gynecol 2012; 120 (6): 1522–1526.

    Article  Google Scholar 

  2. 2

    Yao AC, Lind J . Effect of gravity on placental transfusion. Lancet 1969; 2 (7619): 505–508.

    CAS  Article  Google Scholar 

  3. 3

    Farrar D, Airey R, Law GR, Tuffnell D, Cattle B, Duley L . Measuring placental transfusion for term births: weighing babies with cord intact. BJOG 2011; 118 (1): 70–75.

    CAS  Article  Google Scholar 

  4. 4

    Yao AC, Moinian M, Lind J . Distribution of blood between infant and placenta after birth. Lancet 1969; 2 (7626): 871–873.

    CAS  Article  Google Scholar 

  5. 5

    Oh W, Lind J . Venous and capillary hematocrit in newborn infants and placental transfusion. Acta Paediatr Scand 1966; 55 (1): 38–48.

    CAS  Article  Google Scholar 

  6. 6

    Cernadas J, Carroli G, Pellegrini L, Otano L, Ferreira M, Ricci C . The effect of timing of cord clamping on neonatal venous hematocrit values and clinical outcome at term: a randomized controlled trial. Obstet Gynecol Survey 2006; 61 (9): 564–565.

    Article  Google Scholar 

  7. 7

    Oh W, Lind J . Body temperature of the newborn infant in relation to placental transfusion. Acta Paediatr Scand 1967; 172S: 137–145.

    Article  Google Scholar 

  8. 8

    Pietra GG, D'Amodio MD, Leventhal MM, Oh W, Braudo JL . Electron microscopy of cutaneous capillaries of newborn infants: effects of placental transfusion. Pediatrics 1968; 42 (4): 678–683.

    CAS  PubMed  Google Scholar 

  9. 9

    Oh W, Oh MA, Lind J . Renal function and blood volume in newborn infant related to placental transfusion. Acta Paediatr Scand 1966; 55: 197–210.

    Article  Google Scholar 

  10. 10

    Nelle M, Zilow EP, Bastert G, Linderkamp O . Effect of Leboyer childbirth on cardiac output, cerebral and gastrointestinal blood flow velocities in full-term neonates. Am J Perinatol 1995; 12 (3): 212–216.

    CAS  Article  Google Scholar 

  11. 11

    McDonald SJ, Middleton P, Dowswell T, Morris PS . Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. Cochrane Database Syst Rev 2013; 7: Cd004074.

    Google Scholar 

  12. 12

    Erickson-Owens DA, Mercer JS, Oh W . Umbilical cord milking in term infants delivered by cesarean section: a randomized controlled trial. J Perinatol 2012; 32 (8): 580–584.

    CAS  Article  Google Scholar 

  13. 13

    Mercer JS, Erickson-Owens DA . Rethinking placental transfusion and cord clamping issues. J Perinat Neonatal Nurs 2012; 26 (3): 202–217.

    Article  Google Scholar 

  14. 14

    AAP. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics 2004; 114 (1): 297–316.

    Article  Google Scholar 

  15. 15

    Sarkar S, Rosenkrantz TS . Neonatal polycythemia and hyperviscosity. Semin Fetal Neonatal Med 2008; 13 (4): 248–255.

    Article  Google Scholar 

  16. 16

    Mimouni FB, Merlob P, Dollberg S, Mandel D . Neonatal polycythaemia: critical review and a consensus statement of the Israeli Neonatology Association. Acta Paediatr 2011; 100 (10): 1290–1296.

    Article  Google Scholar 

  17. 17

    Rao R, Georgieff MK . Iron in fetal and neonatal nutrition. Semin Fetal Neonatal Med 2007; 12 (1): 54–63.

    Article  Google Scholar 

  18. 18

    Chaparro CM, Neufeld LM, Tena Alavez G, Eguia-Liz Cedillo R, Dewey KG . Effect of timing of umbilical cord clamping on iron status in Mexican infants: a randomised controlled trial. Lancet 2006; 367 (9527): 1997–2004.

    CAS  Article  Google Scholar 

  19. 19

    Gupta R, Ramji S . Effect of delayed cord clamping on iron stores in infants born to anemic mothers: a randomized controlled trial. Indian Pediatr 2002; 39 (2): 130–135.

    PubMed  Google Scholar 

  20. 20

    Andersson O, Hellstrom-Westas L, Andersson D, Domellof M . Effect of delayed versus early umbilical cord clamping on neonatal outcomes and iron status at 4 months: a randomized controlled trial. BMJ 2011; 343: d7157.

    Article  Google Scholar 

  21. 21

    Nelson N, Enkin MW, Saigal S, Bennett KJ, Milner R, Sackett DL . A randomized trial of the Leboyer approach to childbirth. N Engl J Med 1980; 302: 655–660.

    CAS  Article  Google Scholar 

  22. 22

    Vain NE, Satragno DS, Gorenstein AN, Gordillo JE, Berazategui JP, Alda MG et al. Effect of gravity on volume of placental transfusion: a multicentre, randomised, non-inferiority trial. Lancet 2014; 384 (9939): 235–240.

    Article  Google Scholar 

  23. 23

    Nelle M, Zilow EP, Kraus M, Bastert G, Linderkamp O . The effect of Leboyer delivery on blood viscosity and other hemorheologic parameters in term neonates. Am J Obstet Gynecol 1993; 169 (1): 189–193.

    CAS  Article  Google Scholar 

  24. 24

    Bassiouny MR, El-Chennawi F, Mansour AK, Yahia S, Darwish A . Optimal method for collection of umbilical cord blood: an Egyptian trial for a public cord blood bank. Transfusion 2015; 55 (6): 1263–1268.

    CAS  Article  Google Scholar 

  25. 25

    Wu S, Xie G, Wu J, Chen J, Lu Y, Li Y et al. Influence of maternal, infant, and collection characteristics on high-quality cord blood units in Guangzhou Cord Blood Bank. Transfusion 2015; 55 (9): 2158–2167.

    Article  Google Scholar 

  26. 26

    Jelin AC, Kuppermann M, Erickson K, Clyman R, Schulkin J . Obstetricians' attitudes and beliefs regarding umbilical cord clamping. J Matern Fetal Neonatal Med 2014; 27 (14): 1457–1461.

    Article  Google Scholar 

  27. 27

    Zahir F, Rabbani G, Khan RH, Rizvi SJ, Jamal MS, Abuzenadah AM . The pharmacological features of bilirubin: the question of the century. Cell Mol Biol Lett 2015; 20 (3): 418–447.

    CAS  Article  Google Scholar 

  28. 28

    Upadhyay A, Gothwal S, Parihar R, Garg A, Gupta A, Chawla D et al. Effect of umbilical cord milking in term and near term infants: randomized control trial. Am J Obstet Gynecol 2013; 208 (2): 120.e121–e126.

    Article  Google Scholar 

  29. 29

    Begum F, Zaman T, Khan RM . Effect of early and delayed umbilical cord clamping of term infants on mothers and neonates. Int Gynecol Obstet 2012; 119 (S3): s295.

    Google Scholar 

  30. 30

    Christensen RD, Yaish HM . Hemolytic disorders causing severe neonatal hyperbilirubinemia. Clin Perinatol 2015; 42 (3): 515–527.

    Article  Google Scholar 

  31. 31

    Bhutani VK, Srinivas S, Castillo Cuadrado ME, Aby JL, Wong RJ, Stevenson DK . Identification of neonatal haemolysis: an approach to predischarge management of neonatal hyperbilirubinemia. Acta Paediatr 2016; 105 (5): e189–e194.

    CAS  Article  Google Scholar 

  32. 32

    Garabedian C, Rakza T, Drumez E, Poleszczuk M, Ghesquiere L, Wibaut B et al. Benefits of delayed cord clamping in red blood cell alloimmunization. Pediatrics 2016; 137 (3): 1–6.

    Article  Google Scholar 

  33. 33

    Strauss RG, Mock DM, Johnson KJ, Cress GA, Burmeister LF, Zimmerman MB et al. A randomized clinical trial comparing immediate versus delayed clamping of the umbilical cord in preterm infants: short-term clinical and laboratory endpoints. Transfusion 2008; 48 (4): 658–665.

    Article  Google Scholar 

  34. 34

    Christensen RD, Baer VL, Gerday E, Sheffield MJ, Richards DS, Shepherd JG et al. Whole-blood viscosity in the neonate: effects of gestational age, hematocrit, mean corpuscular volume and umbilical cord milking. J Perinatol 2014; 34 (1): 16–21.

    CAS  Article  Google Scholar 

Download references


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.

Author information



Corresponding author

Correspondence to J S Mercer.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

Further reading