The finding of Pladys et al (1), that preterm infants are able to compensate for deficiencies in hematocrit by increasing cardiac output is reassuring. However, it would seem to be a good idea to attempt to minimize the need for such efforts, which are another added stress to an already overburdened newborn’s system.

There is a simple procedure with little, if any risk that can increase red cell transport or oxygen-carrying capacity and help reduce the need for increased stress on the cardiovascular system. I am referring to the practice of delayed clamping of the umbilical cord.

I would like to take this opportunity to extol some of the virtues of this practice, since there are numerous health benefits that can be reaped, especially in regards to increased red cell transport and other hematological factors.

Hematocrit levels and neonatal blood volume have been shown to increase significantly, with clamping being delayed for 3 minutes (2). The increase in blood volume due to placental transfusion is especially significant in premature infants due to the fact that a lower percentage of the total feto-placental circulation is in the fetal circulation, as compared with term infants. The hypovolemic state that most preterm infants face, can thereby be eliminated or at least reduced.

It has also been shown to increase iron stores substantially, which may help in the prevention of a later deficiency (3). Additionally, initial packed cell volume and blood viscosity increases and median red cell transfusion requirements decrease with late clamping (4). Lastly, losses of crucial stem cells are reduced, providing numerous benefits (5).

In addition to the clinical benefits of late clamping, it has also been proposed to result in significant healthcare cost savings (4,5).

Unfortunately, immediate cord clamping is apparently the standard practice with preterm deliveries, in most areas, although I hope that this may change. Although there is still ongoing research on this topic, changes in standard practice need not wait for these results. This is because it is the practice of immediate clamping that is the intervention, which requires justification. Delayed clamping is the normal physiological approach that should not be abandoned without just cause.

References:

1. Pladys P, Beuchee A, Wodey E, Tison L, Betremieux P. Haematocrit and red blood cell transport in preterm infants: an observational study. Arch Dis Child Fetal Neonatal Ed 2000; 82: F150-155.

2. Linderkamp O, Nelle M, Kraus M, Zilow EP. The effect of early and late cord clamping on blood viscosity and other hemorheological parameters in full-term neonates. Acta Paediatr 1992; 81: 745-50.

3. Pisacane A. Neonatal prevention of iron deficiency. Placental transfusion is a cheap and physiological solution. BMJ 1996; 312: 136- 137.

4. Kinmond S, Aitchison TC, Holland BM, Jones JG, Turner TL, Wardrop CA. Umbilical cord clamping and preterm infants: a randomised trial. BMJ 1993; 306: 172-175.

5. Wardrop CA, Holland BM. The roles and vital importance of placental blood to the newborn infant. J Perinat Med 1995; 23: 139-143.