Optimal Timing for Umbilical Cord Clamping - Literature review Example

Optimal Timing for Umbilical Cord Clamping Students Name Institution of Learning Literature Review Introduction A delayed cord clamping refers to a birth practice that involves cutting the umbilical cord a few minutes later after or after the pulsations have stopped. It can also refer to the cutting session after the placenta has been delivered. This practice is being practiced by a number of parents for their babies (Ceriani Cernadas, et al, 2006). The clamping timing of the umbilical cord has a number of sizable effects on the outcomes of both mother and the baby. Research has indicated that when the cord clamping is delayed the neonate manages to obtain up to 30% more of the fatal-placental blood volume compared to a point where immediate cord clamping is practiced (Blouin, 2011). It is note able that when a baby is born the placenta and the cord system contains around 1/3 of the baby’s blood, whereas the enduring two thirds is in the baby. Some of the delayed clamping practice benefits includes; a healthy, normal blood capacity for the move to life out of the womb (Bhatt, 2013). There is also a full count of the stem, immune and red blood cells. In the side of the mother the practice helps to retain the mother baby unit intact preventing complications with delivering the placenta. Search Strategy The studies reviewed in this article were obtained through a variety of sources, such as EBSCO Host. Some references were available through the Wiley Online Library, Medline, and CINAHL. The keywords entered were cord clamping, delayed, immediate, early, late, and term in the Cochrane Database of Systematic Reviews, ProQuest and Science Direct database of the Wiley Online Library. The reference lists were also used as a source of additional articles. Exclusions The idea time for umbilical cord clamping has remained a controversial subject and debate. There are numerous randomized precise trials in preterm infants and term that have evaluated the paybacks of this practice in comparison to immediate umbilical cord clamping practice, thus the most appropriate cord clamping time has until now is still to established (Anderson, Domellöf, Andersson, and Hellström-Westas, 2013). The Articles used in this review were restricted to those from developed countries, written in English, and whose publication date is from 2005 to present. Another exclusion was on isolated studies whose results for preterm infants only were excluded (Zaramella, Freato, Quaresima 2008). This exclusion was based on industrialized countries following the benefits of the practice for the term new born who needs weighing against possible increased urge for photo-therapy, particularly in settings where initial discharge of term and near-term new born is a mutual practice Review of the Literature The red blood cells in an infant are can be reduced up to 50% by an immediate cord clumping. This results to both potential long and short term neonatal complications. Cord clamping studies have shown that both in randomized and non-randomized studies undergoes and cord clamping delay of up to 3 minutes to cessation of pulsations, deprived of polycythaemia and hyperbilirubinemia Symptoms. There are robust benefits of this with diminutive, if any, and contrary effects to both the mother and her infant (Hutchon, 2012). There are numerous classic studies on the effectiveness and effects of this practice that have been conducted. Many authors have taken note of the fact that the placenta blood transfer is fast done into the neonate subsequent to birth and delays of about 3 minutes can have crucial impacts on the blood capacity that is transferred during birth time. It is clear that instant umbilical cord clamping practice holds 30% of the neonate’s blood and can persist in the placenta (Erickson-Owens, and Mercer, 2012). During the first 20 to 25 seconds after a baby has been born blood flow continues in the arteries of the umbilical from the newborn to the placenta. The placental residual capacity in record had virtually 40% less LCC group compared to the ICC group, and the assessed neonatal blood capacity amounted to 7.1% more than that of ECC. Results of literature review Delayed cord clamping practice has been recommend as a low cost, feasible intervention that can help in reducing anaemia in the low and middle income countries where there is increased rate of iron deficiency cases. In the review of ideal scheduling for umbilical cord clamping, diverse in jaundice or polycythaemia were negligible in the infant holding mode on maternal abdomen, below the placenta or at infant held at introitus position during and at the end of pulsations cord management (Hutton, Stoll, and Taha, 2012). The delayed amount of time in the clamping practice in all holding modes was 3 minutes. In the case of maternal abdomen and in a dc group the blood capacity was 32% higher. According to authors the EC denies new born babies a placental transfusion increasing the hypoglycemia and anemia risk. There was an increase in the rate of haematocrits with more distinct pulmonary vasodilation in first 5 days 2 (Gyorkos, et al 2012).In the introitus position the residual blood capacity increased with EC. The blood viscosity increased at 2 hr which was 40% higher, raised bilirubin. In addition there were no infants who showed clinical symptoms. Another important results to focus on is delay when pulsations stopped both when an infant is on maternal abdomen (Coggins, and Mercer, 2009). The DC group indicated an elevated jaundice which were statistically significant. There was no any clear benefit on EC side .In addition, there were no differences in polycythaemia or jaundice that were found. It is also important to note that the above results were for both randomized controlled and controlled study. Discussion In the last 50 to 100 years in human existence, there is a high likelihood that the new born baby’s umbilical cord pulsated till it closed impulsively. Along with crucial advancements in neonatology and obstetrics the present practice of instant umbilical cord clamping has developed in numerous institutions irrespective of adequate research on its possible short and long term impacts (Chaparro, Neufeld, Alavez, Cedillo, and Dewey, 2006). The literature under this area is flocked with various references that are unsubstantiated to the fact that a delayed cord clamping procedure results into a wide range of harmful effects .At this time the belief that a delay in cord clamping results into polycythemia is so dominant to a point that one regularly finds it specified in the literature as a putative fact not requiring scientific references (Smith, Plaat, and Fisk, 2008). The impression that delayed cord clamping practice is harmful is not reinforced by the findings from both randomized controlled trials as well as, trials that are also controlled and which have been completed in the past two decades connecting term infants. Areas of controversy There are concerns on the delayed umbilical cord clamping practices that mainly includes the possible precipitation hyperviscosity, polycythaemia, hyperbilirubinemia, and the newborn transient tachypnea. These are the controversial areas in in this review. Earlier, immediate umbilical cord clamping practice was considered to act as a prevention in postpartum haemorrhage (Mercer, et al., 2010). According to novel opinion from the Royal College of Obstetricians and Gynaecologists, it was noted that early cord clamping practice resulted into being a routine practice irrespective of rigorous evaluation. Nevertheless, there is a controversy that is still surrounding this issue. The concerns in regard to delayed umbilical cord clamping practice ought to comprise of polycythaemia and jaundice of the neonate. Though the asymptomatic polycythaemia complication is commonly associated with delayed cord clamping, there are no it significant changes in the bilirubin level within the first three days of life. Further research There are additional issues apart from the ones discussed in this review that needs further clarification. Some of these aspects includes; the idea position to hold a new born relative to placenta, particularly after a caesarean birth process; the best to conduct umbilical cord clamping for infants with high risk in multiple gestation and fatal polycythaemia (Vain, et al 2014). Another area worth further research is the optimal cord clamping in increased risk among mothers, for instance, those with a positive human immunodeficiency virus, and bleeding from placenta abruption. The final research area is on the conceivable impacts of late cord clamping on umbilical cord acid–base status and blood gases. As the answers to above issues arises it is clear that there is prudent need to follow the regional society recommendations in order to be able to incorporate the delayed umbilical cord clamping practice at least 30s, whenever feasible. There is need to take record of the clamping cord time for all births preferably in both the mother and infant medical records (Committee on Obstetric Practice, 2012). This acts as an alert to the healthcare givers as well as the paediatric team in their monitor task. It is also important in bilirubin position and to device appropriate follow-up plans.\ Conclusion The discussion concerning optimal timing of umbilical cord clamping is in an obstetric set up that has continued for over numerous years. As indicated in the further research section, it is an area that requires extensive research in order to have a clear picture of the whole issue in regard to optimal time for delayed umbilical cord clamping practice. References Andersson, O., Domellöf, M., Andersson, D. and Hellström-Westas, L. (2013) Effects of Delayed Cord-Clamping on Neurodevelopment and Infection at Four Months of Age: A Randomised Trial. Acta Paediatrica, 102, 525-531. Andersson, O., Hellström-Wesras, L., Andersson, D., Clausen, J. and Domellöf, M. (2012) Effects of Delayed Compared with Early Umbilical Cord Clamping on Maternal Postpartum Hemorrhage and Cord Blood Gas Sampling: A Randomized Trial. Acta Obstetricia et Gynecologica Scandinavica, 92, 567-574. Bhatt, S., Alison, B.J., Wallace, E.M., Crossley, K.J., Gill, A., Kluckow, M., tePas, A.B., Morley, C.J., Polglase, G.R. and Hooper, S.B. (2013) Delaying Cord Clamping until the Onset of Ventilation Improves Cardiovascular Function at Birth in Preterm Lambs. The Journal of Physiology, 591, 2113-2126. Blouin, B., Penny, M., Casapia, M., Eder, A., Hermann, S., Joseph, S., Creed-Kanashiro, M., Maheu-Giroux, M. and Gyorkos, T.W. (2011) Effect of a Two-Component Intervention to Change Hospital Practice from Early to Delayed Umbilical Cord Clamping in the Peruvian Amazon. Revista Panamericana de Salud Pública, 29, 322-328. Ceriani Cernadas, J.M., Carroli, G., Pellegrini, L., Otaño, L., Ferreira, M., Ricci, C., Casas, O., Giordano, J. and Lar J. (2006) The Effect of Timing of Cord Clamping on Neonatal Venous Hematocrit Values and Clinical Outcome at Term: A Randomized, Controlled Trial. Pediatrics, 117, e779-e786. Chaparro, C.M., Neufeld, L.M., Alavez, G.T., Cedillo, R.E. and Dewey, K.G. (2006) Effect of Timing of Umbilical Cord Clamping on Iron Status in Mexican Infants: A Randomised Controlled Trial. The Lancet, 376, 1248-1253. Coggins, M. and Mercer, J. (2009) Delayed Cord Clamping: Advantages for Infants. Nursing for Women’s Health, 13,133-139. Committee on Obstetric Practice (2012) Timing of Umbilical Cord Clamping after Birth. Committee Opinion, 120,1522-1526. Erickson-Owens, D.A., Mercer, J.S. and Oh, W. (2012) Umbilical Cord Milking in Term Infants Delivered by Cesarean Section: A Randomized Controlled Trial. Journal of Perinatology, 32, 580-584. Gyorkos, T.W., Maheu-Girous, M., Blouin, B., Creed-Kanashiro, H., Casapia, M., Aguilar, E., Silva, H., Joseph, S. and Penny, M.E. (2012) A Hospital Policy Change toward Delayed Cord Clamping Is Effective in Improving Hemoglobin Levels of Anemic Status of 8-Month-Old Peruvian Infants. Journal of Tropical Pediatrics, 58, 435-440. Hutton, E.K., Stoll, K. and Taha, N. (2012) An Observational Study of Umbilical Cord Clamping Practices of Maternity Care Providers in a Tertiary Care Center. Birth, 40, 39-45. Hutchon, D. (2012) Immediate or early cord clamping vs delayed clamping. Journal of Obstetrics and Gynecology, Nov., 32(8): 724-9 Mercer, J.S., Vohr, B.R., Erickson-Owens, D.A., Padbury, J.F. and Oh, W. (2010) Seven-Month Developmental Outcomes of Very Low Birth Weight Infants Enrolled in a Randomized Controlled Trial of Delayed versus Immediate Cord Clamping. Journal of Perinatology, 30, 11-16. Smith, J., Plaat, F. and Fisk, N. (2008) The Natural Caesarean: A Woman-Centred Technique. BJOG: An International Journal of Obstetrics & Gynaecology, 115, 1037-1042. Vain, N.E., Satragno, D.S., Gorenstein, A.N., Gordillo, J.E., Berazategui, J.P., Alda, M.G. and Rudent, L.M. (2014) Effect of Gravity on Volume of Placental Transfusion: A Multicenter, Randomized, Non-Inferiority Trial. The Lancet, 384, 235-240. Zaramella P, Freato F, Quaresima V, (2008).Early versus late cord clamping:effects on peripheral blood flow and cardiac function in term infants.Early Hum Dev 84:195–200. Read More