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Review | Clinician's Corner

Late vs Early Clamping of the Umbilical Cord in Full-term Neonates: Systematic Review and Meta-analysis of Controlled Trials

Eileen K. Hutton, PhD; Eman S. Hassan, MBBCh
JAMA. 2007;297(11):1241-1252. doi:10.1001/jama.297.11.1241.
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Published online

Context With few exceptions, the umbilical cord of every newborn is clamped and cut at birth, yet the optimal timing for this intervention remains controversial.

Objective To compare the potential benefits and harms of late vs early cord clamping in term infants.

Data Sources Search of 6 electronic databases (on November 15, 2006, starting from the beginning of each): the Cochrane Pregnancy and Childbirth Group trials register, the Cochrane Neonatal Group trials register, the Cochrane library, MEDLINE, EMBASE, and CINHAL; hand search of secondary references in relevant studies; and contact of investigators about relevant published research.

Study Selection Controlled trials comparing late vs early cord clamping following birth in infants born at 37 or more weeks' gestation.

Data Extraction Two reviewers independently assessed eligibility and quality of trials and extracted data for outcomes of interest: infant hematologic status; iron status; and risk of adverse events such as jaundice, polycythemia, and respiratory distress.

Data Synthesis The meta-analysis included 15 controlled trials (1912 newborns). Late cord clamping was delayed for at least 2 minutes (n = 1001 newborns), while early clamping in most trials (n = 911 newborns) was performed immediately after birth. Benefits over ages 2 to 6 months associated with late cord clamping include improved hematologic status measured as hematocrit (weighted mean difference [WMD], 3.70%; 95% confidence interval [CI], 2.00%-5.40%); iron status as measured by ferritin concentration (WMD, 17.89; 95% CI, 16.58-19.21) and stored iron (WMD, 19.90; 95% CI, 7.67-32.13); and a clinically important reduction in the risk of anemia (relative risk (RR), 0.53; 95% CI, 0.40-0.70). Neonates with late clamping were at increased risk of experiencing asymptomatic polycythemia (7 studies [403 neonates]: RR, 3.82; 95% CI, 1.11-13.21; 2 high-quality studies only [281 infants]: RR, 3.91; 95% CI, 1.00-15.36).

Conclusions Delaying clamping of the umbilical cord in full-term neonates for a minimum of 2 minutes following birth is beneficial to the newborn, extending into infancy. Although there was an increase in polycythemia among infants in whom cord clamping was delayed, this condition appeared to be benign.

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Figures

Figure 1. Mean Hematocrit and Hemoglobin Levels Among Infants With Late Cord Clamping (LCC) Relative to Early Cord Clamping (ECC)
Graphic Jump Location

Sizes of data markers indicate the weight of each study in the analysis. CI indicates confidence interval.

Figure 2. Mean Blood Viscosity Among Infants With Late Cord Clamping (LCC) Relative to Early Cord Clamping (ECC)
Graphic Jump Location

Sizes of data markers indicate the weight of each study in the analysis. CI indicates confidence interval.

Figure 3. Mean Bilirubin Levels Among Infants With Late Cord Clamping (LCC) Relative to Early Cord Clamping (ECC)
Graphic Jump Location

Sizes of data markers indicate the weight of each study in the analysis. CI indicates confidence interval. To convert bilirubin values to mg/dL, divide by 17.1.

Figure 4. Mean Ferritin Concentrations at Ages 2 to 3 Months Among Infants With Late Cord Clamping (LCC) Relative to Early Cord Clamping (ECC)
Graphic Jump Location

Sizes of data markers indicate the weight of each study in the analysis. CI indicates confidence interval. To convert values to pmol/L, multiply by 2.247.

Figure 5. Anemia at Ages 2 to 3 Months Among Infants With Late Cord Clamping (LCC) Relative to Early Cord Clamping (ECC)
Graphic Jump Location

Sizes of data markers indicate the weight of each study in the analysis. CI indicates confidence interval.

Figure 6. Clinical Jaundice and Need for Phototherapy Among Infants With Late Cord Clamping (LCC) Relative to Early Cord Clamping (ECC)
Graphic Jump Location

Sizes of data markers indicate the weight of each study in the analysis. CI indicates confidence interval.

Figure 7. Polycythemia Among Infants With Late Cord Clamping (LCC) Relative to Early Cord Clamping (ECC)
Graphic Jump Location

Sizes of data markers indicate the weight of each study in the analysis. CI indicates confidence interval.

Figure 8. Tachypnea or Grunting Among Infants With Late Cord Clamping (LCC) Relative to Early Cord Clamping (ECC)
Graphic Jump Location

Sizes of data markers indicate the weight of each study in the analysis. CI indicates confidence interval.

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