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

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