Early versus delayed umbilical cord clamping in preterm infants

RHL practical aspects by Ceriani Cernadas JM

FIRST CONTACT (PRIMARY CARE LEVEL)

Health-care centres at the primary care level in developing countries are usually not suitably equipped to deliver very-low-birth-weight preterm infants as they require special care. Therefore, where possible, such deliveries should be performed at the referral level. If a preterm delivery does take place at the primary care level, cord clamping should be performed at 30 seconds after delivery in infants who are born later than 31–32 completed weeks of gestation and whose health status is otherwise good.

REFERRAL HOSPITAL (SECONDARY CARE) LEVEL

The Cochrane review concluded that delaying cord clamping by 30–120 seconds appears to be associated with less need for transfusion and less intraventricular haemorrhage. As justified in the commentary, there are good reasons to introduce delayed clamping, keeping in mind the special circumstances where this may not apply (e.g. in cases of fetal distress and intrauterine asphyxia).

Referral hospitals are well-suited to implement the practice of delayed cord clamping in preterm infants. There are no specific guidelines on the best way of introducing a change in the practice of cord clamping. Experience from other areas of perinatal medicine suggests that it is possible to change practices when improvements in health care of patients is the prime motivation (1). No change is possible if the leaders (heads of departments, heads of nurseries, supervisors, etc.) are not interested in the programme and are not involved in an active way (2). Start by convening a meeting of all health-care workers (including heads) caring for mothers and children. Emphasize that there is an intention to evaluate the possibility of a change in the practice of umbilical cord clamping in preterm infants with a view to improving health-care outcomes. Allow everyone express their opinions and motivate people to work for towards an agreed, stated goal. Once an initial agreement is reached, constitute an interdisciplinary group of 8–10 professionals to develop the needed strategies, activities and the time-line. This should be relatively easy because delaying cord clamping is itself quite simple: it requires that health-care staff wait for approximately one minute before clamping the cord.

AT HOME OR IN THE COMMUNITY

It is important for the mothers to know about the possible advantages of delayed cord clamping and have the opportunity to discuss this issue with their obstetrician.

References

  • Horbar JD, Plsek PE, Leahy K. Establishing habits for improvement in Neonatal Intensive Care Units. Pediatrics 2003;111:397–410.
  • Green PL, Plsek PE. Coaching and leadership for the diffusion of innovation in healthcare: a different type of multi-organization improvement collaborative. The Joint Commission Journal on Quality Improvement 2002;28:55–71.

This document should be cited as: Ceriani Cernadas JM. Early versus delayed umbilical cord clamping in preterm infants : RHL practical aspects (last revised: 7 March 2006). The WHO Reproductive Health Library; Geneva: World Health Organization.

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