Delayed Umbilical Cord Clamping after Birth - Research Paper Example

Delayed Umbilical Cord Clamping after Birth In the history of human birth, the cutting of the umbilical cord has served primarily symbolic purpose insofar as it represents the final severing of a physical connection between mother and infant. However, the debate over whether there are indeed health benefits for the infant (and potentially for the mother) continues in the research literature. A large number of studies and meta-analyses demonstrate the benefits of a form of clamping a newborn’s umbilical cord that waits for a short period of time postnatal. Among the most common benefits these studies cite are blood transfers to prevent anemia, stem cell transfers, and transfers of iron reserves (Chaparro et al., 2007). Nevertheless, the traditional practice of clamping the umbilical cord immediately postnatal continues, primarily for the sake of either compensating for a lack of resources, lack of time, or for the facilitation of umbilical cord banking. Despite perceived or apparent disadvantages of a delayed clamping procedure, the research literature makes evident the fact that a delayed clamping bestows benefits on an infant in almost all cases. For this reason, the recommendation that all births conform to the delayed clamping method stands. Section II Sometime immediately after the birth of a child, in most cases, the umbilical cord connecting mother and infant is clamped and cut. This can take place as early as one minute (what is called “immediate” clamping) or as late as five minutes (what is called “delayed” clamping). Once the cord is clamped, it is cut painlessly by the nurse. Because the cord lacks nerve endings, the thick layers of the cord can be done away with a sharp instrument. Although clamping the cord occurs normally between one and five minutes postnatal, cutting can be delayed or omitted entirely. Usually, the cord stops pulsing between five and twenty minutes postnatal, and at that point it is cut. However, the debate over cord clamping refers to the one to five minutes postnatal, prior to the actual cutting procedure. The practices of both delayed versus immediate clamping of the umbilical cord developed simultaneously, and before the extensive research devoted to the issue now, depended largely on the preference of the individual (or team) delivering the baby. Delayed clamping is, however, a somewhat new phenomenon, simply because infant mortality rates in the developed world has decreased through the past century and our understanding of prenatal stem cells has increased (Tolosa, Park, Eve, Klasko, Borlongan, & Sanberg, 2010). In fact, the delayed clamping procedure does not restrict the transfer of stem cells that empties from the umbilical cord, which the authors of Tolosa et al. (2010) characterize as “the original stem cell transplant”. Clarifying the difference between immediate and delayed clamping, their meta-analysis of many different studies analyzing the effects of both procedures recommends waiting for more than a minute, or perhaps even until after the cord stops pulsating to clamp. Section III Hutton and Hassan (2007) examined registers of full-term newborns and contacted secondary sources to study the effect of clamping times on infants. Although, according to the authors, a vast majority of newborns have their umbilical cord severed immediately after birth, they found that delaying clamping of umbilical cords in full-term newborns for at least two minutes postnatal is advantageous to the infant. After looking at 15 different controlled trials, they isolated the benefits of delayed clamping between 2 to 6 months to improved hematologic status, iron status as measured by ferritin concentration, and a clinically significant reduction in the risk of developing anemia (Hutton & Hassan, 2007). Searches for significance with respect to other common conditions and problems after birth, such as jaundice and respiratory distress, came up empty. Based on these results, the authors recommend that current practices in nursing change to reflect the findings of the studies they evaluated in their meta-analysis. Likewise, Mercer, Vohr and McGrath (2006) effect of late versus early clamping of the umbilical cord postnatal. Methodologically, this meta-analysis differed from Hutton and Hassan (2007) insofar as Mercer et al. examined the effect of clamping time on the health of very preterm infants. A very preterm infant is one exhibiting very low birth weight. In their study, Mercer et al. randomly assigned 72 women/infant pairs to either an early or late clamping condition. At 28 weeks postnatal, the mean weight of immediate clamped infants was 1151g and the mean weight of delayed clamped infants was 1175g. Their results revealed a trend toward higher initial hematocrit in the infants in the delayed group, meaning the infants. Among their other significant results was the finding that delayed cord clamping appears to protect very low birth-weight infants from intraventricular hemorrhage (IVH) and late-onset sepsis (LOS). These results are important because they have the potential for a tremendous clinical application to preterm infants. If a physician believes an infant will be brought to term well before the expected delivery date, and that the infant will experience postnatal health problems, there can be reason to support a delayed umbilical cord clamping. These applications extend to low-research areas where cheap and effective interventions are required to reduce the risk of infant anemia. This is particularly important in developing countries, where simply adjusting the timing of umbilical cord clamping can have a positive impact. From the results of van Rheenen, Gruschke and Brabin (2006), one sees a success in applying this procedure to achieve maximal results for infant hemoglobin. This result brought about a significant reduction in the blood transfusions needed for infants, which has the added benefit of saving blood reserves of the developing countries’ hospitals. Their study also looks at preterm infants (called in this case “small-for-gestational-age”), and marks a success of the delayed cord clamping (DCC) method. According to the authors, no adverse effects of the practice exist (van Rheenen, Gruschke, & Brabin, 2006, p. 157). Problems regarding umbilical cord banking can exist when the cord clamping, which is necessarily prior to the actual cutting procedure, is delayed. Regardless of that case, in the majority of cases where umbilical stem cells are not kept, delayed clamping is the more desirable practice. Immediate cord clamping is a practice that remains in widespread use because it is the common practice, not for any specific justifiable clinical reason. In many cases of very preterm infants, the clamping is immediate because resuscitation and stabilization of infants is necessary to save the child’s life. In that case, the timing of the clamp is of the utmost importance, and obviously the benefits of waiting to clamp the cord would not outweigh the benefits of clamping it immediately to give the child the care it needs. In most other cases, the belief that immediate clamping is a superior method is based on a notion of delayed clamping as potentially dangerous either for the infant or the mother, which is demonstrably false (Tolosa, Park, Eve, Klasko, Borlongan, & Sanberg, 2010). Insofar as these objections fail to carry weight, they fail to dispute the role of delayed clamping in improving infantile fitness in both full-term and pre-term infants. When umbilical cords are clamped before necessary transfusions to the infant have taken place, blood volume may be extracted from other capillary beds to cause hypoperfusion (Gutierrez, Velasquez, & Iriarte, 2010). This kind of hemodynamic instability in the newborn may result in ischemic lesions in the brain, gastrointestinal tract, and lungs. Approximately one-quarter to one-half of the placental blood volume is excluded from the infant’s circulation if the cord is clamped before the newborn begins spontaneous breathing. To prevent these kinds of postnatal respiratory problems, delayed clamping of the umbilical cord helps to avoid hypoperfusion and anemia. Section IV Potential barriers to the widespread use of delayed clamping are few, since the difference between immediate and delayed clamping is a matter of timing. As previously mentioned, problems in delaying the clamping procedure include the required resuscitation and stabilization of unhealthy newborns and the misperception that delaying the clamp can cause unseen problems for the infant and/or mother. The first case is not a problem but an exception in terms of the cost/benefit scenario. The second case can be addressed by proper education and further research into how the benefits (and costs) of the delayed procedure play out through the long-term. Section V The clinical and physiologic effects of delayed cord clamping were first studied by Walsh (1968) in a study that concluded that the time of cord clamping (delayed versus immediate) has hemodynamic effects in the infant; according to their results, immediate cord clamping deprives the newborn of a significant blood volume. More than 40 years later, these results are being replicated over and over again in a slew of new studies that show the beneficial health effects of delaying the umbilical cord clamp beyond the traditional thirty seconds to two minutes postnatal. Given the numerous benefits outlined above of this procedure, one would expect a paradigm shift in how nurses and doctors treat the umbilical cord; nevertheless, like in other areas of nursing, what stands true of practice remains so because it is the standard operating procedure. Both in developed and developing countries, and with full-term and preterm infants, delayed clamping has been shown to make healthier infants beyond the time of the actual birth. As van Rheenen et al. (2006) point out, there are no discernible adverse effects to delaying the umbilical clamp as far as twenty minutes after birth. With any luck, this research literature will persuade the medical community to change the standard ways of operating. References Chaparro, C., Fornes, R., Neufeld, L., Alavez, G., Cedillo, R., & Dewey, K. (2007). Early umbilical cord clamping contributes to elevated blood lead levels among infants with higher lead exposure. The Journal of Pediatrics, 151, 506-512. Gutierrez, A., Velasquez, R., & Iriarte, M. (2010). Analysis of clinical course in term patients with early and delayed umbilical cord clamping after birth. The Internet Journal of Pediatrics and Neonatology, 11. Hutton, E., & Hassan, E. (2007). Late vs. early clamping of the umbilical cord in full-term neonates: Systematic review and meta-analysis of controlled trials. Journal of the American Medical Association, 297, 1241-1252. Mercer, J., Vohr, B., McGrath, M., Padbury, J., Wallach, M., & Oh, W. (2006). Delayed cord clamping in very preterm infants reduces the incidence of intraventricular hemorrhage and late-onset sepsis: A randomized, controlled trial. Pediatrics, 117, 1235-1242. Tolosa, J., Park, D., Eve, D., Klasko, S., Borlongan, C., & Sanberg, P. (2010). Mankind’s first natural stem cell transplant. Journal of Cellular and Molecular Medicine, 14, 488-495. van Rheenen, P., Gruschke, S., & Brabin, B. (2006). Delayed umbilical cord clamping for reducing anaemia in low birthweight infants: implications for developing countries. Annals of Tropical Paediatrics: International Child Health, 26, 157-167. Walsh, S. (1968). Maternal effects of early and late clamping of the umbilical cord. Lancet, 1, 996-997. Read More