Rethink prompted on immediate cord clamping for pre-term babies

A major review has found that changing how pre-term babies’ umbilical cords are clamped could improve outcomes and save babies’ lives, prompting an update of the international guidelines that inform global practice.

More than 15 million babies are born too early (preterm) annually worldwide. Of these, 1.1 million die, and surviving children have an increased risk of developmental difficulties and chronic ill health.

Now, an international research team led by the University of Sydney has brought together all clinical trials to date looking at different strategies for clamping of the umbilical cord for preterm infants in a systematic review and meta-analysis, from 42 studies incorporating data for almost 6000 infants.

This study forms the evidence basis for the forthcoming treatment recommendations by the International Liaison Committee for Resuscitation (ILCOR). ILCOR forms a liaison between principal resuscitation organisations worldwide, including in Australia and New Zealand, the US, Asia, South Africa and Europe.

The findings published recently in the leading pediatric medicine journal, Pediatrics.

Based on this review, ILCOR’s treatment recommendations are expected to be made available for public consultation within the next few days and once finalised, will inform clinical guidelines and practice worldwide.

Lead author of the study Dr Anna Lene Seidler, a research fellow at the NHMRC Clinical Trials Centre based at the University’s Faculty of Medicine and Health, said that the new study would influence clinical practice globally.

‘We found that delaying cord clamping at preterm birth seems to improve infant outcomes, so clinicians should consider this strategy unless the baby requires immediate resuscitation.’

“What is referred to as milking the cord – squeezing the cord towards the baby to push blood from the cord to the baby – may also be considered as an alternative strategy, but not for babies that are born very preterm, before 28 weeks’ gestational age’.

"I expect our review will influence clinical practice, toward more clinicians waiting until they clamp the cord in preterm infants, or considering cord milking as an alternative,’ Dr Seidler said.

"This is particularly significant since these techniques are so easy and cheap to apply, they don’t require any specialised equipment.’

The review follows research by the NHMRC CTC that suggested delaying cord clamping improved survival rates. There remain some unanswered questions, regarding which strategy works best – delayed clamping or cord milking - and whether different strategies should be applied to different babies.

For this reason, the researchers have formed the iCOMP Collaboration, a global alliance of experts and clinicians in this area. It brings together the actual datasets from all relevant trials, currently 118 planned, ongoing or completed trials including more than 15,000 babies, in a large combined database; it is one of the largest databases this research field has ever seen.Professor Helen Liley, (University of Queensland and honorary researcher, the University of Sydney) who is vice-chair of ILCOR’s Neonatal Life Support Task Force, commended Dr Seidler on the new important review.

“We expect this new research will have very rapid translation into clinical guidelines, and international practice everywhere,” Professor Liley said, noting a simultaneous review was being conducted for full-term- and near-term infants, the treatment recommendations for which will be released for public consultation simultaneously.

Once the pre-term cord clamping treatment recommendations are available on the ILCOR website, there will be a comment function for experts, clinicians and the public to submit their feedback to the ILCOR taskforce. The submissions link will be available via costr.ilcor.org/.

Declaration: Dr Seidler is the chair of the individual participant data on Cord Management at Preterm Birth (iCOMP) collaboration. This review was funded by the American Heart Association, on behalf of the International Liaison Committee on Resuscitation (ILCOR). It has also been supported in part by the Vermont Oxford Network, funded by the National Institutes of Health (NIH).