Q: How long do you wait to clamp a cord?

Too many red cellsWhen I was doing neonates, it was considered good practice to get little babies spliced away from their Mother, given oxygen to breathe and wrapped up warm, all pretty damn quickly. I keep hearing rumours from my neonatally biased friends that perhaps there are other, better ways of doing things.

So – how long do you advise waiting until clamping the umbilical cord after delivery? Two, three minutes (where the baby can chill & develop polycythaemia?) or as little time as it takes you to get hold of a clamp (so the child can be deprived of the last few teaspoons of good fetal blood?).

A team at Northwick Park are examining the evidence for this question. If you can’t decide, or want to raise your opinions, feel free to comment below.

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  • Of course, the real question is whether the baby is preterm or not.

    Delayed cord clamping of 30-60 seconds was popular in the 80s, and has been suggested as effective vs NEC, BPD and IVH. Recent systematic review suggests that it may well prevent IVH and need for blood transfusion [Neonatology. 2008;93(2):138-44. Epub 2007 Sep 21].

    Milking the cord works in ELBW babies, in this study it even reduced days ventilated [ Arch Dis Child Fetal Neonatal Ed. 2008 Jan;93(1):F14-9. Epub 2007 Jan 18].

    For term babies, the benefits are likely to be minimal, and the necessary studies would have to be huge.

  • leonard williams

    Of course, the really really real question is why do you clamp the cord at all.
    If you do not clamp the cord, the baby will be transfused, the placenta will be smaller and more easily delivered, and because of this there will be less reflux of fetal blood into the mothers circulation.
    If the baby needs to be taken away quickly, one clamp should be applied and the cord cut on the maternal side of that clamp.
    If bloods need to be taken from the cord, apply two clamps, cut in between,then remove the clamp on the mother’s end and allow the blood to flow into the container. Slight modification of this would be necessary to take cord gases.
    What did humans do before cord clamps were invented and why were they introduced? I believe the answer is that they were introduced in the Victorian age to save laundry services.