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Effect of delayed versus early umbilical cord clamping on neonatal outcomes and iron status at 4 months: a randomised controlled trial

BMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d7157 (Published 15 November 2011) Cite this as: BMJ 2011;343:d7157

Rapid Response:

Re: Effect of delayed versus early umbilical cord clamping on neonatal outcomes and iron status at 4 months: a randomised controlled trial

This paper and others clearly indicate a statistically significant benefit in terms of infant iron status at four months. It is based on a low-risk population with normal vaginal delivery. It would appear that the researchers collected some data on breastfeeding. It is easy to see how the advice given could be applied in practice to normal vaginal deliveries; delayed cord clamping may be less practical at instrumental vaginal delivery and Caesarean Section. At normal deliver does the baby need to be maintained below the level of the uterus to benefit from placental transfusion? At instrumental vaginal delivery the neonate is usually delivered onto the maternal abdomen (if not requiring resuscitation); will such a location maintain the benefit of placental transfusion or is there a risk of reverse transfusion?

Do the researchers data on breastfeeding give any indication as to whether delayed clamping (through delaying “skin-to-skin”) impacts on breastfeeding rates?

Despite the statistical significance of the benefit in terms of improved iron status the actual benefit seems small, is it possible to give a number-needed-to-treat (NNT)?

Competing interests: No competing interests

20 November 2011
Malcolm Griffiths
Consultant Obstetrician
Luton & Dunstable Hospital
Lewsey Road, Luton, LU4 0DZ, UK