Re: Effect of delayed versus early umbilical cord clamping on neonatal outcomes and iron status at 4 months: a randomised controlled trial
Regarding Dr. Yablin's question concerning "overloading":
Delayed cord clamping has been associated with different aspects of volume overload; such as circulatory and respiratory changes and/or polycytaemia resulting in plethora. In our study, we could not see any differences between groups regarding overloading, but this was not extensively studied. We report respiratory symtoms at one and six hours after birth, packed cell volume at two days and admission to NICU.
Dr Nelle et. al published four studies on circulatory changes due to delayed cord clamping, in summary showing short term, physiologic differences in comparison to early cord clamping. (Ref 1-4)
Three different reviews of the literature have not found any serious symptoms of overload (Ref 5-7)
1: Nelle M, Kraus M, Bastert G, Linderkamp O. Effects of Leboyer childbirth on left- and right systolic time intervals in healthy term neonates. J Perinat Med. 1996;24(5):513-20. PubMed PMID: 8950732.
2: Nelle M, Zilow EP, Bastert G, Linderkamp O. Effect of Leboyer childbirth on cardiac output, cerebral and gastrointestinal blood flow velocities in full-term neonates. Am J Perinatol. 1995 May;12(3):212-6. PubMed PMID: 7612098.
3: Nelle M, Zilow EP, Kraus M, Bastert G, Linderkamp O. The effect of Leboyer delivery on blood viscosity and other hemorheologic parameters in term neonates. Am J Obstet Gynecol. 1993 Jul;169(1):189-93. PubMed PMID: 8333451.
4: Linderkamp O, Nelle M, Kraus M, Zilow EP. The effect of early and late cord-clamping on blood viscosity and other hemorheological parameters in full-term neonates. Acta Paediatr. 1992 Oct;81(10):745-50. PubMed PMID: 1421876.
5: Mercer JS. Current best evidence: a review of the literature on umbilical cord clamping. J Midwifery Womens Health. 2001 Nov-Dec;46(6):402-14. Review. PubMed PMID: 11783688.
6: McDonald SJ, Middleton P. Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. Cochrane Database Syst Rev. 2008 Apr 16;(2):CD004074. Review. PubMed PMID: 18425897.
7: Hutton EK, Hassan ES. Late vs early clamping of the umbilical cord in full-term neonates: systematic review and meta-analysis of controlled trials. JAMA. 2007 Mar 21;297(11):1241-52. Review. PubMed PMID: 17374818.
Rapid Response:
Re: Effect of delayed versus early umbilical cord clamping on neonatal outcomes and iron status at 4 months: a randomised controlled trial
Regarding Dr. Yablin's question concerning "overloading":
Delayed cord clamping has been associated with different aspects of volume overload; such as circulatory and respiratory changes and/or polycytaemia resulting in plethora. In our study, we could not see any differences between groups regarding overloading, but this was not extensively studied. We report respiratory symtoms at one and six hours after birth, packed cell volume at two days and admission to NICU.
Dr Nelle et. al published four studies on circulatory changes due to delayed cord clamping, in summary showing short term, physiologic differences in comparison to early cord clamping. (Ref 1-4)
Three different reviews of the literature have not found any serious symptoms of overload (Ref 5-7)
1: Nelle M, Kraus M, Bastert G, Linderkamp O. Effects of Leboyer childbirth on left- and right systolic time intervals in healthy term neonates. J Perinat Med. 1996;24(5):513-20. PubMed PMID: 8950732.
2: Nelle M, Zilow EP, Bastert G, Linderkamp O. Effect of Leboyer childbirth on cardiac output, cerebral and gastrointestinal blood flow velocities in full-term neonates. Am J Perinatol. 1995 May;12(3):212-6. PubMed PMID: 7612098.
3: Nelle M, Zilow EP, Kraus M, Bastert G, Linderkamp O. The effect of Leboyer delivery on blood viscosity and other hemorheologic parameters in term neonates. Am J Obstet Gynecol. 1993 Jul;169(1):189-93. PubMed PMID: 8333451.
4: Linderkamp O, Nelle M, Kraus M, Zilow EP. The effect of early and late cord-clamping on blood viscosity and other hemorheological parameters in full-term neonates. Acta Paediatr. 1992 Oct;81(10):745-50. PubMed PMID: 1421876.
5: Mercer JS. Current best evidence: a review of the literature on umbilical cord clamping. J Midwifery Womens Health. 2001 Nov-Dec;46(6):402-14. Review. PubMed PMID: 11783688.
6: McDonald SJ, Middleton P. Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. Cochrane Database Syst Rev. 2008 Apr 16;(2):CD004074. Review. PubMed PMID: 18425897.
7: Hutton EK, Hassan ES. Late vs early clamping of the umbilical cord in full-term neonates: systematic review and meta-analysis of controlled trials. JAMA. 2007 Mar 21;297(11):1241-52. Review. PubMed PMID: 17374818.
Competing interests: No competing interests