Delayed cord clamping does not affect umbilical cord blood gas analysis
Although delayed umbilical cord clamping has been shown to have significant benefits for both term and preterm infants, currently, data on its impact on blood gas analysis have been scant and conflicting.
In a retrospective review, we compared the demographic characteristics and blood gas parameters of 114 delayed cord clamping (DCC—births between 45 and 90 s in length; 109 being for 60 s) versus 407 early cord clamping births (ECC—immediately after delivery) collected over a 1-year period. Intrapartum care and timing of cord clamping for individual cases were performed at the discretion of obstetricians. The differences were assessed for statistical and clinical significance.
The DCC group was found to have significantly higher mean Apgar scores at both 1 and 5 min (p < 0.05), as well as lower percentages of nulliparous births, cesarean-section deliveries, epidural anesthesia usage, and major pregnancy-related complications. No significant differences in maternal age, gestational age, neonate birthweight, sex, or in the presence of meconium at birth were observed. A higher umbilical artery pO2 in the DCC group [21 (9) vs. 19 (10) mmHg, p < 0.05] was the only statistically significant difference found out of all the blood gas parameters analyzed.
In this study, infants selected for the DCC procedure were found to be overall lower risk than those delivered as per the standard ECC procedure. No clinically significant difference in any blood gas parameter was observed, and therefore, no adjustment to clinical reference intervals is needed for DCC blood gas samples taken after a 1-min delay period.
KeywordsDelayed cord clamping Early cord clamping Blood gas Neonate Pregnancy
YC and S-LS contributed to the conception of the project. JT and RF collected data. JT and YC did data analysis and drafted the original manuscript. YC, S-LS, and RF critically revised the manuscript for intellectual content. All of the authors approved the final version to be published and agreed to act as guarantors of the work.
Compliance with ethical standards
Conflict of interest
No potential conflict of interest relevant to this manuscript was reported.
All DCC and ECC cases of vigorous term and preterm infants between February 2017 and February 2018 were retrospectively reviewed with a study protocol approved by the Institute Research Ethics Board (File #: 2018-2614). Maternal and neonatal demographic variables including maternal and gestational age, parity, mode of delivery, epidural anesthesia usage, neonate birthweight, Apgar scores at 1 and 5 min, sex, presence of meconium at birth, and major pregnancy-related complications (including gestational diabetes mellitus, chorioamnionitis, and cholestasis, etc.), were pulled from medical records and compared.
Informed consent was waived with the approval of the Research Ethics Board of Horizon Health Network.
Human and animal rights statement
This article does not contain any studies with animals performed by any of the authors.
- 2.Linderkamp O, Nelle M, Kraus M, Zilow EP (1992) The effect of early and late cord-clamping on blood viscosity and other hemorheological parameters in full-term neonates. Acta Paediatr 81(10):745–750. https://www.ncbi.nlm.nih.gov/pubmed/1421876. Accessed 1 Aug 2018
- 6.Sanberg PR, Divers R, Mehindru A, Mehindru A, Borlongan CV (2014) Delayed umbilical cord blood clamping: first line of defense against neonatal and age-related disorders. Wulfenia 21(6):243–249. https://www.ncbi.nlm.nih.gov/pubmed/25400533. Accessed 1 Aug 2018
- 7.Rabe H, Diaz-Rossello JL, Duley L, Dowswell T (2012) Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes. Cochrane Database Syst Rev 8:CD003248. https://doi.org/10.1002/14651858.CD003248.pub3 Google Scholar
- 11.MacLennan A (1999) A template for defining a causal relation between acute intrapartum events and cerebral palsy: international consensus statement. BMJ 319(7216):1054–1059. https://www.ncbi.nlm.nih.gov/pubmed/10521205. Accessed 28 June 2018
- 12.D’Alton ME, Hankins GDV, Berkowitz RL, Bienstock J, Ghidini A, Goldsmith J, Higgins R, Moore TR, Natale R, Nelson KB, Papile L-A, Peebles D, Romero RJ, Schendel D, Spong CY, Waldman RN, Yvonne W, Joseph GF Jr, Hawks D, Politzer A, Emig C, Thomas K (2014) Executive summary: neonatal encephalopathy and neurologic outcome, second edition. Report of the American college of obstetricians and gynecologists’ task force on neonatal encephalopathy. Obstet Gynecol 123(4):896–901. https://doi.org/10.1097/01.AOG.0000445580.65983.d2 CrossRefGoogle Scholar
- 21.Skovlund E, Fenstad GU (2001) Should we always choose a nonparametric test when comparing two apparently nonnormal distributions? J Clin Epidemiol 54(1):86–92. https://www.ncbi.nlm.nih.gov/pubmed/11165471. Accessed 11 Sept 2018