Grand Rounds

Is Delayed Cord-Clamping Associated with Increased Incidence of Newborn Jaundice?

BACKGROUND AND PURPOSE:

Yang et al. (Obstetrics & Gynecology 2019) evaluated the impact of delayed cord-clamping on bilirubin levels and jaundice in term neonates

Retrospective cohort study
Participants
- >18 years
- Term pregnancy
Data were analyzed from births that were categorized as either
- Non-cord clamping cohort: Before implementation of a universal delayed cord-clamping protocol
- Cord clamping cohort: 5-7 months after implementation of a universal delayed cord-clamping protocol
Primary outcome
- Mean peak neonatal transcutaneous bilirubin level
Secondary outcomes
- Mean initial transcutaneous bilirubin levels
- Mean serum bilirubin levels
- Number of serum bilirubin levels drawn
- Incidence of clinical jaundice
- Need for phototherapy
Adjusted for breast feeding due to potential confounding

Data from 424 neonates
Mean peak transcutaneous bilirubin levels
- Higher in cord clamping group (10.0±3.4 mg/dL) vs non-clamping (8.4±2.7 mg/dL); P<.01
Jaundice
- Higher in cord clamping group (27.2%) vs non-clamping group (16.6%)
- Odds ratio (OR) 1.88 (95% CI, 1.17–3.01)
Number of serum blood draws
- Higher in cord clamping group (43.7%) vs non-clamping group (29.4%)
- OR 1.86 (95%, CI 1.25–2.78)
There was no difference between groups for
- Mean peak serum bilirubin levels (P=.17)
- Need for phototherapy (OR 1.28; 95% CI 0.57–2.89)
There was no change in the results when adjusted for feeding method/ breastfeeding
Subanalysis performed to remove maternal and fetal conditions associated with hyperbilirubinemia and comparison was performed between delayed and immediate clamping
- Results were essentially unchanged

Delayed cord-clamping at term was associated with
- Higher mean transcutaneous bilirubin levels
- More serum blood draws
- More diagnoses of jaundice
There was no increase in incidence of phototherapy
Authors conclude that
- “…improved hematologic status and neurocognitive benefit, remain ambiguous”
- This study did not evaluate costs of a jaundice diagnosis nor consequent parental anxiety and such research is warranted “before any definitive recommendations of delayed cord clamping as a best-practice in this population”

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