Timing of umbilical cord clamping after birth for optimizing placental transfusion.

PURPOSE OF REVIEW: A brief delay in clamping the umbilical cord after birth offers health benefits to the newborn, with no adverse effects to the mother or her infant. Yet, in most obstetric practice, the cord is clamped soon after birth. A summary of the current evidence on delayed cord clamping and some reasons for the disconnect between the evidence and practice are discussed here, along with the recommendations from professional organizations and societies about this practice. RECENT FINDINGS: In term infants, umbilical cord clamping between 30 and 180 s after birth results in higher concentrations of hemoglobin and hematocrit during the neonatal period, and increased serum ferritin levels and a lower incidence of iron-deficiency anemia at 4-6 months of age. These are important benefits for children in low and middle income countries where iron-deficiency anemia is highly prevalent. In preterm infants, delayed cord clamping for at least 30 s increases the concentrations of hemoglobin and hematocrit, improves mean systemic blood pressure, urine output, and cardiac function, and decreases the need for vasopressors and blood transfusions during the neonatal period. It also decreases the prevalence of necrotizing enterocolitis, sepsis, and intraventricular hemorrhage (all grades). Milking of the unclamped umbilical cord toward the infant soon after birth also has similar beneficial effects. In some studies, more infants in the delayed cord clamping groups required phototherapy for jaundice. SUMMARY: Many professional organizations, societies, and experts recommend at least a 30-s delay before clamping the umbilical cord, especially after preterm births. The value of this practice for term births in resource-rich settings has not been evaluated.