Early versus Delayed Umbilical Cord Clamping Leads to Neonatal Anemia

Abstract

Objective:  To evaluate whether Early Cord Clamping (ECC) leads to anemia and Delayed Cord Clamping (DCC) could improve the haematological status of infants.

Patients and Methods:  Interventional randomized trial study was carried out over a period of six months from 1^st October, 2010 to 31^st March 2011 in Gyneco-logy Department Lady Willingdon Hospital, Lahore. A detailed questionnaire was prepared. Total 300 cases were randomly allocated after taking informed con-sent. Venous hematocrit values, Bilirubin levels and ferritin were detected after 24 hours, 48 hours and 3 months of neonatal life and the record entered into proforma.

Results:  Neonatal anemia and decreased hematocrit level was found in 32 / 150 (21%) neonates with grea-test significance due to early cord clamping neonatal. While Delayed cord clamping (DCC) resulted with a higher mean hematocrit (45.6 ± 5.6 versus 32.8 ± 7.1 at the end of three months) and hemoglobin concentra-tion (17.4 ± 2.2 g/dL vs 12.5 ± 4.1 g/dL at the end of 3 months), whilst a non-significant difference was obser-ved in mean bilirubin level in DCC group as compared to ECC group (7 ± 2.3 vs 5 ± 3.5 mg/dL in 48 hours). A significant number of infants developed jaundice in DCC group as compared to ECC groups (8% vs 2%; p = 0.016). No infants polycythemia, mother postpartum hemoorhage was seen in both groups. All the jaundice patients recovered with Phototherapy.

Conclusion:  To get the normal hematocrit level in term infants, it is very necessary to avoid early cord clamping and this practice should be changed in mode-rn obstetrical practice as it is not the standard method and the cause of iron deficiency anemia. Delayed cord clamping method increases mean neonatal hematocrit, hemoglobins within a physiologic range and save from developing iron deficiency anaemia although delaying clamping increases the risk of jaundice requiring pho-totherapy.

Key words:  Early Clamping, Hematocrit, Neonatal anemia, Umbilical Cord.