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Matern Health Neonatol Perinatol. 2019 May 30;5:7. doi: 10.1186/s40748-019-0103-y. eCollection 2019.

Effect of early versus delayed cord clamping in neonate on heart rate, breathing and oxygen saturation during first 10 minutes of birth - randomized clinical trial.

Author information

1
1Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
2
2University of Calgary, Calgary, Canada.
3
Paropakar Maternity and Women's hospital, Kathmandu, Nepal.
4
Department of Clinical Sciences Lund, Pediatrics/Neonatology, Skane University Hospital, Lund University, Lund, Sweden.

Abstract

Background:

Delayed cord clamping (DCC) after 180 s reduces iron deficiency up to 8 months of infancy compared to babies who received Early Cord Clamping (ECC) at less than 60 s. Experimentally DCC has shown to improve cardio-vascular stability. To evaluate the effect of delayed (≥180 s) group versus early (≤60 s) cord clamping group on peripheral blood oxygenation and heart rate up to 10 min after birth on term and late preterm infants.

Methods:

We conducted a single centred randomized clinical trial in a low risk delivery unit in tertiary Hospital, Nepal. One thousand five hundred ten women, low risk vaginal delivery with foetal heart rate (FHR) ≥ 100 ≤ 160 beats per minute (bpm) and gestational age (≥33 weeks) were enrolled in the study. Participants were randomly assigned to cord clamped ≤60 s of birth and ≥ 180 s. The main outcome measures were oxygen saturation, heart rate from birth to 10 min and time of spontaneous breathing. The oxygen saturation and heart rate, the time of first breath and establishment of regular breathing was analysed using Student t-test to compare groups. We analysed the range of heart rate distributed by different centiles from the time of birth at 30 s intervals until 10 min.

Results:

The oxygen saturation was 18% higher at 1 min, 13% higher at 5 min and 10% higher at 10 min in babies who had cord clamping in delayed group compared to early group (p < 0.001). The heart rate was 9 beats lower at 1 min and3 beats lower at 5 min in delayed group compared to early group (p < 0.001). Time of first breath and regular breathing was established earlier in babies who had cord clamping at 180 s or more.

Conclusion:

Spontaneously breathing babies subjected to DCC have higher oxygen saturation up to 10 min after birth compared to those who have undergone ECC. Spontaneously breathing babies with DCC have lower heart rates compared to ECC until 390 s. Spontaneously breathing babies receiving DCC have early establishment of breathing compared to ECC.

Trial registration:

ISRCTN, 5 April 2016.

KEYWORDS:

Delayed cord clamping; Heart rate in first 10 min; Oxygen saturation in first 10 min; Randomized clinical trial; Spontaneous breathing; Term and late preterm infants

Conflict of interest statement

Competing interestsThe authors declare that they have no competing interests.

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