A practical approach to timing cord clamping in resource poor settings

doi:10.1136/bmj.39002.389236.BE

BMJ 2006;333:954-958 (4 November), doi:10.1136/bmj.39002.389236.BE

Practice

A practical approach to timing cord clamping in resource poor settings

Patrick F van Rheenen, consultant paediatrician¹, Bernard J Brabin, professor of tropical child health²

¹ Paediatric Gastroenterology, Department of Paediatrics, University Medical Centre Groningen, PO Box 30001, 9700 RB Groningen, Netherlands, ² Emma Children's Hospital-Academic Medical Centre, Amsterdam, Netherlands

Correspondence to: P F van Rheenen p.f.vanrheenen@gmail.com

The first 150 words of the full text of this article appear below.

There is little agreement among doctors and midwives about theoptimal time to clamp the umbilical cord after birth. The mostimportant points of difference relate to maternal and infantsafety. Many healthcare workers worldwide tend to clamp thecord and pass the baby off as quickly as possible. Infants inresource poor settings are the main victims of immediate clamping,as this prevents a cost-free means of boosting their small ironstores.

Infant anaemia is common in poor communities, especially wheremalaria is endemic. In sub-Saharan Africa more than 75% of infantsare anaemic before 6 months of age.^w1-w3 Infant anaemia is associatedwith increased mortality^{w4 w5} and with impaired mental and motordevelopment.^w6 Its prevention is of critical importance, anddelaying clamping of the umbilical cord could be an effectivestrategy to reduce anaemia and improve child survival.

We propose a practice guideline on cord clamping for resourcepoor . . . [Full text of this article]

Clinical questions

Is delayed cord clamping associated with improved haematological status in infancy?
Is delayed cord clamping associated with side effects that require treatment?
Is delayed cord clamping associated with increased maternal blood loss?
How does delayed cord clamping affect obstetric management of the third stage of labour?
Is delayed cord clamping in growth retarded infants associated with more adverse effects?
What is the optimal delay for cord clamping in infants in relation to their position during placental transfusion?
Vaginally born, normal birthweight infants
Vaginally born, low birthweight infants
What is the optimal time of clamping when neonatal resuscitation is required?

Conclusions

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Delayed cord clamping may also be beneficial in rich settings: David J R Hutchon
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This article has been cited by other articles:

(2008). BMFMS: Labour and Delivery. Arch. Dis. Child. Fetal Neonatal Ed. 93: Fa50-Fa67 [Full text]
Kumar, A., Rai, A. K., Basu, S., Dash, D., Singh, J. S. (2008). Cord Blood and Breast Milk Iron Status in Maternal Anemia. Pediatrics 121: e673-e677 [Abstract] [Full text]
Weeks, A. (2007). Umbilical cord clamping after birth. BMJ 335: 312-313 [Full text]
Hutton, E. K., Hassan, E. S. (2007). Late vs Early Clamping of the Umbilical Cord in Full-term Neonates: Systematic Review and Meta-analysis of Controlled Trials. JAMA 297: 1241-1252 [Abstract] [Full text]
Hutchon, D. J R (2006). Delayed cord clamping may also be beneficial in rich settings. BMJ 333: 1073-1073 [Full text]

Rapid Responses:

Read all Rapid Responses

cord clamping in uk: pa price
bmj.com, 4 Nov 2006 [Full text]
Re: cord clamping in uk: David JR Hutchon
bmj.com, 5 Nov 2006 [Full text]
Is there a role for delayed cord clamping in newborns with cyanotic congenital heart disease?: Thomas Krasemann
bmj.com, 6 Nov 2006 [Full text]
Delayed Cord Clamping and HIV: Douwe A A Verkuyl
bmj.com, 10 Nov 2006 [Full text]
Lotus birth: an alternative to cord clamping?: Martino Dall'Antonia
bmj.com, 10 Nov 2006 [Full text]
Delayed Cord Clamping Should be Adopted Immediately: Eileen Nicole Simon, PhD, RN, et al.
bmj.com, 14 Nov 2006 [Full text]
Is there a necessity to clamp on the maternal side of the umbilical cord?: GIRISH K LAKSHMANA
bmj.com, 20 Nov 2006 [Full text]
A Rational Approach to Timing Cord Clamping in Any Setting: George M. Morley
bmj.com, 20 Nov 2006 [Full text]
Risk of HIV with delayed cord clamping: Rory H Wilson
bmj.com, 25 Nov 2006 [Full text]
Examine the effects of immediate Cord Blood Clamping: Norman Ende
bmj.com, 20 Jun 2007 [Full text]