Current Best Evidence: A Review of the Literature On Umbilical Cord Clamping

Authors

  • Judith S. Mercer CNM, DNSc, FACNM

    Corresponding author
      Nurse-Midwifery Program, University of Rhode Island College of Nursing, 2 Heathman Road, Kingston, RI 02881-2021.
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    • Judith S. Melson Mercer received a diploma in nursing from the Johns Hopkins Hospital School of Nursing, a bachelors of science in nursing from the University of Maryland, a masters of science and certificate in midwifery from Columbia University, and a doctorate in nursing from the Catholic University of America. Dr. Mercer served on faculty at Georgetown University for 16 years and directed the nurse-midwifery education program for 10 years. Her practice experience ranges from home births, where her interest in cord clamping began, to medical centers. Currently, she is Director of the University of Rhode Island College of Nursing Nurse-Midwifery Program. She is a Fellow of the American College of Nurse-Midwives.


Nurse-Midwifery Program, University of Rhode Island College of Nursing, 2 Heathman Road, Kingston, RI 02881-2021.

ABSTRACT

Immediate clamping of the umbilical cord can reduce the red blood cells an infant receives at birth by more than 50%, resulting in potential short-term and long-term neonatal problems. Cord clamping studies from 1980 to 2001 were reviewed. Five hundred thirty-one term infants in the nine identified randomized and nonrandomized studies experienced late clamping, ranging from 3 minutes to cessation of pulsations, without symptoms of polycythemia or significant hyperbilirubinemia. Higher red blood cell flow to vital organs in the first week was noted, and term infants had less anemia at 2 months and increased duration of early breastfeeding. In seven randomized trials of preterm infants, benefits associated with delayed clamping in these infants included higher hematocrit and hemoglobin levels, blood pressure, and blood volume, with better cardiopulmonary adaptation and fewer days of oxygen and ventilation and fewer transfusions needed. For both term and preterm infants, few, if any, risks were associated with delayed cord clamping. Longitudinal studies of infants with immediate and delayed cord clamping are needed.

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