Delayed Cord Clamping: Benefits, Risks And Guidelines

The string of life or the Umbilical cord is the gift of love and care during pregnancy from mother to the growing baby and vice versa.¹ It establishes the physical and emotional bridge between the mother and the developing baby inside the womb. But, this string of life should be clamped within 1-3 minutes of birth. Wondering why? Let’s know here but before delving into the topic of delayed cord clamping, it is important to understand the concept of the umbilical cord. 

What Is An Umbilical Cord?

Umbilical Cord is a collection of blood vessels which develops in the early pregnancy. It plays a crucial role in carrying the deoxygenated CO₂ enriched blood away from the baby in womb to the placenta (an organ developed in the uterus during pregnancy to nourish the growing baby).¹ It is also responsible for transferring oxygen and essential nutrients from the mother's blood to the baby.¹

Did you know the umbilical cord is clamped and separated from the placenta during the third stage of labor? In this article we will unfold the mystery of optimal timing of umbilical cord clamping after delivery  and why it is a controversial topic worldwide over centuries. But, before moving ahead, let us first understand what is early and late/delayed umbilical cord clamping.  

What Is Delayed Cord Clamping?

The World Health Organisation defines ‘delayed umbilical cord clamping’ as the clamping of umbilical cord within 1 to 3 minutes of birth or clamping when the pulsation of cords are stopped.² Let us further understand the reasons why delayed cord clamping is beneficial and how it helps a newborn baby.

The Benefits Of Delayed Cord Clamping

Delayed cord clamping is safe, effective and feasible practice for both preterm and term babies. Several studies have confirmed the benefits of delayed cord clamping as described below.

• Clamping the cord after 2-3 min wait post delivery or until the pulsation stops helps in placental transfusion (the process of transferring the blood from placenta to the newborn). This enables the transfer of ample iron reserves for the first 6-8 months after birth, this helps prevent or postpone the risk of iron deficiency (anemia).³
• Delayed cord clamping also aids in decreasing the rate of hemorrhage (loss of blood from a damaged blood vessel), thereby increasing the oxygen flow in brain and lungs to prevent lack of blood supply. It thus, enhances stability of heart and the blood vessels in the newborn baby.²
• Delayed cord clamping promotes brain development and functioning up to four years of age ² by preventing iron deficiency. It is crucial to note that iron deficiency can impede mental development, leading to an IQ that is up to 5-10 points lower. ³
• Delayed cord clamping is not only a boon for the newborn baby but also for the new mothers. It leads to less blood-filled placenta, which in turn reduces the incidence of retained placenta after delivery and helps in active management of the third stage of labor.³

Risks Involved In Delayed Cord Clamping

Although delayed cord clamping has a plethora of benefits for the newborn and is promoted as the best practice by healthcare professionals, still there are a few theoretical barriers which need attention. Let us learn about them here.

• Jaundice - Few studies have shown that there is 4.36% risk of jaundice or yellowing of eyes and skin in babies who had delayed cord clamping.³ Higher levels of bilirubin was reported in those babies which can cause permanent damage to the brain known as kernicterus causing cerebral palsy (inability to move and maintain balance and posture) or hearing loss. On the contrary, only 2.74% risk of jaundice was reported in babies with early cord clamping.³ 

Thus, it is crucial to understand and follow the guidelines and recommendations for delayed umbilical cord clamping to ensure safe practice. Let's learn  about them in the following section.

Delayed Cord Clamping Guidelines And Recommendations

The World Health Organization (WHO) recommends following these guidelines for delayed umbilical cord clamping when reviving an unconscious or seemingly lifeless newborn.

• For newborns who do not require positive-pressure ventilation, it is recommended to delay cord clamping for at least one minute after birth.⁴
• If positive-pressure ventilation is necessary for the newborn, the cord should be clamped earlier based on the infant's condition to ensure effective ventilation.⁴
• Before clamping the cord and providing ventilation for newborns who do not breathe spontaneously, healthcare providers should rub the baby's back 2-3 times.⁴

In 2017, the American College of Obstetricians and Gynecologists (ACOG) recommended delayed umbilical cord clamping in term and preterm newborns for at least 30–60 seconds after birth.⁵

• Delayed cord clamping increases the level of hemoglobin in full-term infants at the time of birth and thus, have positive outcomes on the development of the baby during the first several months.⁵
• It also recommends delayed cord clamping in preterm babies born before 37 weeks of pregnancy to reduce the incidence of transfusions, intraventricular hemorrhage, and necrotizing enterocolitis (inflammation of large intestine).⁵

The SOGC (Society of Obstetricians and Gynaecologists of Canada) also recommends delayed cord clamping in the following cases.

• Delayed cord clamping for 60-120 seconds is recommended in preterm babies (<37 weeks) and extremely preterm babies (<28 weeks).⁶

The Effect Of Delayed Cord Clamping On Blood Stem Cells

The umbilical cord possesses extremely precious stem cells which are valuable for the newborn in reducing the effect and combating more than 90  deadly diseases. These include blood cancer, lymphoma, sickle cell anemia, and some immune and metabolic disorders. ⁷ 

Studies have shown that delaying cord clamping for 180 seconds can increase blood volume by an additional 75 mL. This blood is estimated to contain between 1,100-45,000 hematopoietic stem cells ⁸ , which are versatile stem cells capable of developing into various types of blood cells, including red and white blood cells, as well as platelets.⁹ Thus, expecting parents who are planning to opt for delayed cord clamping and banking their newborn’s stem cells must look out for the best processing method to ensure high efficiency with less volume of cord blood. Let us have a look at the recommended methodology in the following section.

Pentastarch Cord Blood Processing System

The processing method has a large impact on the quality of stem cell collection after delayed cord clamping, which can ultimately lead to a different outcome if it is used in transplantation. The processing method should allow a higher number of Total Nucleated Cells (TNC) and CD34+ cells (the hematopoietic stem cells) after the cord blood processing to increase chances of successful engraftment.¹⁰ Thus, parents planning to combine both delayed cord clamping and umbilical cord blood collection should opt for Pentastarch processing.

In a study published in the International Journal of stem cells, it was found that Pentastarch processing is the most flexible and the only processing method type which is unaffected by volume of the cord blood.¹¹ It is a US FDA 510K approved processing system manufactured under US FDA's current Good Manufacturing Practices (cGMP). Compared to other methods, Pentastarch processing enables better recovery and higher yield of viable CD34+ progenitor cells and TNC from even a small volume of cord blood.¹² 

LifeCell is the only cord blood bank that uses the most advanced Pentastarch cord blood processing technology in India for stem cell banking. It allows higher stem cell recovery, improves the outcome of stem cell transplant and saves your money by reducing the post transplant recovery time to just 16 days which is the fastest compared to other processing technologies.