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Introitus position not necessary for delayed cord clamping

Monday April 21, 2014
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Changing where a newborn baby is held before its umbilical cord is clamped could lead to improved uptake in hospitals of delayed cord clamping, leading to a decreased risk of iron deficiency in infancy, according to an Argentinean study.

Delaying clamping of the umbilical cord until around two minutes after birth allows for blood to pass from the mother’s placenta to the baby, and has previously been shown to reduce the risk of iron deficiency in infancy, according to a news release on the study, which was published April 17 on the website of The Lancet.

However, current recommendations — based on studies conducted 35 years ago — suggest that for effective placental transfusion to occur, the baby needs to be held in the introitus position, which is cumbersome, uncomfortable for the person holding the baby and interferes with immediate contact between mother and baby.

Since these issues could affect compliance with this procedure in hospitals, ultimately resulting in higher than necessary levels of iron deficiency in babies and children, a group of researchers in Argentina tested whether the transfer of blood in delayed cord clamping procedures is affected by the position in which the baby is held immediately after birth.

In the study, which was conducted at three university-affiliated hospitals in Argentina, 197 babies were held in the introitus position while undergoing delayed cord clamping, as per usual practice, but 194 babies were instead immediately placed on the mother’s abdomen or chest.

By measuring the babies’ weights at the point of birth, and immediately after the delayed cord clamping procedure, the researchers were able to measure the volume of blood that had transferred from the placenta to the child.

They found no statistically significant difference between the two groups in the volume of blood transferred, indicating that placing the baby on the mother’s chest or abdomen is no less effective than the more awkward introitus position in delayed cord clamping procedures.

“Iron deficiency in newborn babies and children is a serious public health problem in low-income countries, and also prevalent in countries from North America and western Europe,” Nestor Vain, MD, the study’s lead author and professor at the Foundation for Maternal and Child Health in Buenos Aires, said in the news release. “Our study suggests that when umbilical cord clamping is delayed for two minutes, holding the baby on the mother’s chest or abdomen is no worse than the currently recommended practice of holding the baby below this level.

“Because of the potential of enhanced bonding between mother and baby, increased success of breast-feeding and the compliance with the procedure, holding the infant by the mother immediately after birth should be strongly recommended.”

In an accompany commentary, Tonse Raju, MD, of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Md., wrote: “Introduction of delayed cord clamping into practice has been sporadic, with logistical issues being one possible reason. Intuitively, to keep the newborn baby’s position below the level of the placenta in situ should maximize the volume of placental transfusion. However, trying to hold on to a wet, vigorously crying and wriggling infant at the perineum for two minutes, in gloved hands, is awkward and can be risky. When the mother is waiting anxiously to hold her baby and the father is taking photographs, two minutes could seem like an eternity.

“The study by Nestor Vain and colleagues in The Lancet should bring a sigh of relief from those trying to incorporate delayed umbilical cord clamping into practice. …The results are convincing and show that gravity did not have an effect on volume of placental transfusion.”

Study abstract: http://bit.ly/1f2xByD


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