Sunday, July 06, 2008

Newest Cochrane review on delayed cord clamping

The latest version of the Cochrane review of delayed cord clamping was published this month in Obstetrics and Gynecology. Effect of Timing of Umbilical Cord Clamping at Birth of Term Infants on Mother and Baby Outcomes confirms yet again that the benefits of delayed cord clamping have been oversold.
We included 11 trials of 2989 mothers and their babies... For neonatal outcomes, our review showed both benefits and harms for late cord clamping. Following birth, there was a significant increase in infants needing phototherapy for jaundice (RR 0.59, 95% CI 0.38 to 0.92; five trials of 1762 infants) in the late compared with early clamping group. This was accompanied by significant increases in newborn hemoglobin levels in the late cord clamping group compared with early cord clamping (weighted mean difference 2.17 g/dL; 95% CI 0.28 to 4.06; three trials of 671 infants), although this effect did not persist past six months. Infant ferritin levels remained higher in the late clamping group than the early clamping group at six months.
There are two important things to note about the results of this study:

First, contrary to the claims of homebirth advocates, delayed cord clamping does not affect oxygenation.

Second, increased newborn hemoglobin levels can cause harm as well as a benefit. The delayed cord clamping group was more likely to require phototherapy than the early cord clamping group. In other words, if the baby has normal to high hemoglobin levels to begin with, delaying cord clamping can lead to pathologically high levels of hemoglobin.

The bottom line is that delayed cord clamping provides limited benefits to a limited subset of infants, and is also capable of causing harm.

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