EC Paediatrics

Review Article Volume 12 Issue 11 - 2023

Delayed Umbilical Cord Clamping

Alejandra Itzel Contreras Rivas1*, Estudillo J Gaston2, Padilla M Gabriela3, Hernández F Francisco4, Jimenez G Julio Y5 and Astudillo A Fernando6

1Pediatrics-Neonatology, Doctorate Student in Biological and Health Sciences, Metropolitan Autonomous University, Physician Attached to the Neonatal Intensive Therapy General Hospital of Tlahuac ISSSTE, Attached to the Perinatal/Genetic/Neonatal Diagnostic Center, Fetalvita Institute, CDMX, Mexico
2Gynecology and Obstetrics, Maternal Fetal Medicine, Fetal Surgery, In Charge of the CDMX Perinatal Health Program, Coordinator of the Maternal Fetal Medicine Service, Dario Fernandez General Hospital ISSSTE, General Director of the Perinatal/Genetic/Neonatal Diagnostic Center, Fetalvita Institute, CDMX, Mexico
3Pediatrician, Associated Pediatric Physician Service Hospital General Doctor Dario Fernandez ISSSTE, Mexico
4Gynecology and Obstetrics, Coordinator of Gynecology and Obstetrics Hospital General Doctor Dario Fernandez ISSSTE, Mexico
5Gynecology and Obstetrics, Responsable de Unidad en: Especialidades Médicas de JOJUTLA, UNEME, Mexico
6Gynecology and Obstetrics, Hospital UCI Almati, Iguala Guerrero, Médico Adscrito En Área de Ginecologia y Obstetricia de HGZ Numero 4, IMSS, Iguala Guerrero, Mexico

*Corresponding Author: Alejandra Itzel Contreras Rivas, Pediatrics-Neonatology, Doctorate Student in Biological and Health Sciences, Metropolitan Autonomous University, Physician Attached to the Neonatal Intensive Therapy General Hospital of Tlahuac ISSSTE, Attached to the Perinatal/Genetic/Neonatal Diagnostic Center, Fetalvita Institute, CDMX, Mexico.
Received: September 19, 2023; Published: October 13, 2023



Currently performing delayed clamping of the umbilical cord (DCC) has become an essential component of labor management and immediate newborn care, the World Health Organization (WHO) recommends delayed clamping of the umbilical cord, no earlier than 1 minute, after birth to improve nutritional and health outcomes for both mother and baby. This volume supports the process of fetal to neonatal physiologic circulatory transition compared with immediate cord clamping, which deprives neonates of a significant volume of blood to support the major changes in the pulmonary and umbilical circulations, especially in preterm neonates. The main problem is when a newborn is born who needs support during resuscitation, that is, they did not breathe or cry at birth, which is why this review will attempt not only to deepen the physiological conditions that improve the binomial and to establish which newborns are candidates to carry out this procedure.

 Keyword: Newborn; Delayed Clamp; Umbilical Cord; Preterm Label

  1. Hofmeyr GJ., et al. “Evidence-based antenatal interventions to reduce the incidence of small vulnerable newborns and their associated poor outcomes”. The Lancet10389 (2023): 1733-1744.
  2. Zhou L., et al. “Feasibility of cord blood collection for autologous cell therapy applications in extremely preterm infants”. Cytotherapy 5 (2023): 458-462.
  3. Handley SC., et al. “Exposure to umbilical cord management approaches and death or neurodevelopmental impairment at 22-26 months' corrected age after extremely preterm birth”. Archives of Disease in Childhood - Fetal and Neonatal Edition3 (2023): 224-231.
  4. Smith ER., et al. “Mesenchymal Stem Cell Identification After Delayed Cord Clamping”. Reproductive Sciences5 (2023): 1565-1571.
  5. Olofsson P. “Umbilical cord pH, blood gases, and lactate at birth: normal values, interpretation, and clinical utility”. American Journal of Obstetrics and Gynecology5S (2023): S1222-S1240.
  6. Lakshminrusimha S., et al. “Differential Alveolar and Systemic Oxygenation during Preterm Resuscitation with 100% Oxygen during Delayed Cord Clamping”. American Journal of Perinatology6 (2023): 630-637.
  7. Ramaswamy VV., et al. “Placental Transfusion Strategies in Preterm Infants in Low- and Middle-Income Countries: A Systematic Review and Network Meta-Analysis”. Neonatology1 (2023): 118-133.
  8. Prachukthum S., et al. “Premature infants receiving delayed cord clamping with and without cord milking: a randomized control trial”. BMC Pediatrics3 (2023): 123.
  9. Katheria AC., et al. “Umbilical cord milking in nonvigorous infants: a cluster-randomized crossover trial”. American Journal of Obstetrics and Gynecology2 (2023): 217.e1-217.e14.
  10. Salcido C., et al. “Maternal bleeding complications and neonatal outcomes following early versus delayed umbilical cord clamping in cesarean deliveries for very low birthweight infants”. Journal of Perinatology1 (2023): 39-43.
  11. Jeevan A., et al. “Umbilical cord milking versus delayed cord clamping in term and late-preterm infants: a systematic review and meta-analysis”. Journal of Maternal-Fetal and Neonatal Medicine25 (2022): 5478-5488.
  12. Schenone CV., et al. “Neonatal blood pressure before and after delayed umbilical cord clamping”. Journal of Maternal-Fetal and Neonatal Medicine25 (2022): 5260-5264.
  13. De Angelis C., et al. “Effect of delayed versus immediate umbilical cord clamping in vaginal delivery at term: A randomized clinical trial”. International Journal of Gynecology and Obstetrics3 (2022): 898-902.
  14. Chiruvolu A., et al. “Variations in umbilical cord clamping practices in the United States: a national survey of neonatologists”. Journal of Maternal-Fetal and Neonatal Medicine19 (2022): 3646-3652.
  15. Koo J., et al. “A newborn's "life line" - A review of umbilical cord management strategies”. Seminars in Perinatology6 (2022): 151621.
  16. Mwamba B. “Delayed cord clamping practice at birth: A narrative review of literature”. European Journal of Obstetrics and Gynecology and Reproductive Biology 277 (2022): 116-121.
  17. Atia H., et al. “The hematological impact of umbilical cord milking versus delayed cord clamping in premature neonates: a randomized controlled trial”. BMC Pregnancy and Childbirth9 (2022): 714.
  18. Smolich JJ. “Understanding the physiology of immediate and delayed umbilical cord clamping at birth: Need for evidence-based pathway to reduce confusion”. Journal of Physiology15 (2022): 3627-3631.
  19. Zhu J., et al. “Epidemiological Investigation on the Current Practice of Umbilical Cord Clamping in China”. American Journal of Perinatology9 (2022): 1015-1019.
  20. Lu Y and Zhang ZQ. “Neonatal hemorrhage stroke and severe coagulopathy in a late preterm infant after receiving umbilical cord milking: A case report”. World Journal of Clinical Cases16 (2022): 5365-5372.
  21. Rabe H., et al. “Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes”. Cochrane Database of Systematic Reviews9 (2019).
  22. McDonald SJ., et al. “Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes”. Cochrane Database of Systematic Reviews 7 (2013): CD004074.
  23. Yunis M., et al. “Effect of delayed cord clamping on stem cell transfusion and hematological parameters in preterm infants with placental insufficiency: a pilot randomized”. European Journal of Pediatrics1 (2021): 157-166.
  24. Yunis M., et al. “Effect of delayed cord clamping on stem cell transfusion and hematological parameters in preterm infants with placental insufficiency: a pilot randomized trial”. European Journal of Pediatrics1 (2021): 157-166.
  25. Ozbasli E., et al. “Effects of cord clamping timing in at-term elective cesarean section on maternal and neonatal outcomes: a randomized trial”. Archives of Gynecology and Obstetrics (2023).
  26. Herold J., et al. “Effects of timing of umbilical cord clamping for mother and newborn: a narrative review”. Archives of Gynecology and Obstetrics (2023).
  27. Yan J., et al. “The Short and Long Term Consequences of Delayed Cord Clamping on Late Pre-Term Infants”. International Journal of Women's Health 15 (2023): 361-368.
  28. Kilicdag H., et al. “Effects of spontaneous first breath on placental transfusion in term neonates born by cesarean section: A randomized controlled trial”. Frontiers in Pediatrics (2022): 10.
  29. Singh L., et al. “A clinical study of fetal outcome following early and delayed cord clamping in births associated with anemia in pregnancy”. Journal of Family Medicine and Primary Care5 (2022): 1789-1793.
  30. Fogarty M., et al. “Delayed vs early umbilical cord clamping for preterm infants: a systematic review and meta-analysis”. American Journal of Obstetrics and Gynecology1 (2018): 1-18.
  31. Chapman J., et al. “Effectiveness of delayed cord clamping in reducing postdelivery complications in preterm infants: a systematic review”. The Journal of Perinatal and Neonatal Nursing4 (2016): 372-378.
  32. Chen X., et al. “Effect and safety of timing of cord clamping on neonatal hematocrit values and clinical outcomes in term infants: a randomized controlled trial”. Journal of Perinatology3 (2017): 251-257.
  33. Mercer JS., et al. “Effects of delayed cord clamping on residual placental blood volume, hemoglobin and bilirubin levels in term infants: a randomized controlled trial”. Journal of Perinatology3 (2017): 260-264.
  34. Ertekin AA., et al. “Term babies with delayed cord clamping: an approach in preventing anemia (.)”. Journal of Maternal-Fetal and Neonatal Medicine17 (2016): 2813-2816.
  35. Tiemersma S., et al. “Delayed cord clamping in South African neonates with expected low birthweight: a randomised controlled trial”. Tropical Medicine and International Health2 (2015): 177-183.
  36. Kc A., et al. “Effects of delayed umbilical cord clamping vs early clamping on anemia in infants at 8 and 12 months: a randomized clinical trial”. JAMA Pediatrics3 (2017): 264-270.
  37. Dicky O., et al. “Delayed umbilical cord clamping in preterm infants born before 37 weeks of gestation: a prospective observational study”. Archives de Pédiatrie2 (2017): 118-125.
  38. Liu LY., et al. “Evaluation of introduction of a delayed cord clamping protocol for premature neonates in a high-volume maternity center”. Obstetrics and Gynecology5 (2017): 835-843.
  39. Nevill E and Meyer MP. “Effect of delayed cord clamping (DCC) on breathing and transition at birth in very preterm infants”. Early Human Development7 (2015): 407-411.

Alejandra Itzel Contreras Rivas., et al. Delayed Umbilical Cord Clamping. EC Paediatrics 12.11 (2023): 01-06.