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Grand Rounds

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

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BACKGROUND AND PURPOSE:

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

METHODS:

  • 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

RESULTS:

  • 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

CONCLUSION:

  • 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”

Learn More – Primary Sources:

Association of a Delayed Cord-Clamping Protocol With Hyperbilirubinemia in Term Neonates

Now You Can Get ObG Clinical Research Summaries Direct to Your Phone

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Related ObG Topics:

What is the Optimal time of Cord Clamping in Preterm Newborns?
Is There Benefit to 3 Minute Delay in Umbilical Cord Clamping?
Is Umbilical Cord Milking of Benefit to Preterm Infants?

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