Delaying cord clamping is linked to improvements in fine motor skillsBMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h2828 (Published 27 May 2015) Cite this as: BMJ 2015;350:h2828
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Sadly the research news article reporting the important long term follow-up of babies after delayed cord clamping by Andersson et al encourages the misunderstanding about what actually happens during neonatal transition if the cord is not clamped quickly. Wise states that the ”fetal blood remaining in the placental circulation to be transfused back into the newborn baby” but during transition the circulation continues, although steadily reducing, with blood being pumped out into the placenta by the neonatal heart, while at the same time blood is returning to the neonate. The increased blood volume results from a higher blood flow back from the placenta than there is going out. As Rabe et al state in the JAMA editorial “The effects of redistributing placental blood into healthy full-term newborns at birth by delayed umbilical cord clamping (CC) have been demonstrated in many studies.” As they state it is correctly a redistribution of blood volume from the placenta to the body of the newborn baby. Small redistributions of blood volume within our bodies occur all the time, but they are not transfusions.
Wise points out that there were limitations to the Andersson study as one third of babies were lost to follow-up. However this is trivial compared with the 50% protocol violations in the unpublished 1996 McDonald study included in the Cochrane Systematic Review.(1)
The absence of harm of delayed cord clamping is also emphasized but since it is early cord clamping which is the intervention, the importance of the absence of any benefit from early cord clamping is the really important message which practitioners need to grasp (2), in addition to the potential for enormous benefit.
1. McDonald SJ, Middleton P, Dowswell T, Morris PS. Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. Cochrane Database Syst Rev. 2013;7:CD004074.
2. Hutchon DJ(2015) Ventilation before umbilical cord clamping improves physiological transition at birth or “Umbilical cord clamping before ventilation is established destabilises physiological transition at birth”. Front. Pediatr. 3:29.
Competing interests: No competing interests