Effect of delayed versus early cord clamping on hemoglobin level of neonates born to anemic mothers

Introduction: In common obstetric practice, the cord is clamped soon after birth. Deferring cord clamping for 2–3 minutes after birth or when cord pulsations stop allows blood flow between baby and placenta to continue for a few moments. Recent research provides evidence for the beneficial effect of delayed cord clamping (DCC) on infant iron status and hemoglobin (Hb) levels. Iron deficiency anemia is a major public health problem in young children worldwide. The increase in neonatal blood volume seen with DCC has the potential both to increase iron stores and Hb concentrations. This study is conducted as the anemia is highly prevalent among the pregnant females in Pakistan; thus, they are likely to reproduce children with low Hb levels. Presently, early cord clamping (ECC) is a common practice in labor suites across Pakistan, but hypothetically speaking, huge benefits were anticipated from delayed clamping.
Methodology: All patients fulfilling the inclusion and exclusion criteria were selected from Labor Room/Emergency Department of the hospital. The patients were not aware of the randomization arm and were selected via lottery method. All patients underwent spontaneous vaginal delivery and informed consent was taken for taking baby’s blood sample within 24 hours after birth. DCC/ECC was done according to randomization. Blood sample of the neonates was sent to a standard laboratory within 24 hours after birth for analyzing full blood counts.
Results: The average neonatal Hb(NHb) level in Group A (DCC) was 18.7 mg/dl and the range was 16.2–19.8 mg/dl but in Group B (ECC) the average NHb level was 17.6 mg/ dl and the range was 16.7–19.2 mg/dl. The calculated “t” value is 8.290 (p = 0.000) and thus shows statistically significant difference between the two groups. Hence alternative hypothesis is accepted.
Conclusion: Our study supports that delaying cord clamping to >180 seconds in low- and middle-income countries, where iron deficiency anemia is prevalent among mothers and newborns, may be beneficial as it improves NHb. Thus, delayed clamping of cord should become a standard protocol in obstetrical practice due to its proven benefits over early clamping of cord.

Abstract