Pregnancy and Newborn Health

Umbilical Cord: Impact of Early Clamping on Newborn Health

Despite tremendous advances in recent decades, bacterial infections like sepsis, meningitis, and pneumonia continue to cause about 1/4th of the 3 million newborn fatalities per year. Worldwide, postpartum infections are still the primary cause of newborn morbidity and death. Bacterial colonisation in the umbilical cord may be the source of many of these diseases. The devitalized umbilical cord serves as a suitable medium for bacterial growth after birth, and provides direct access to the neonate‘s bloodstream. Both bacterial colonisation and time to cord separation are affected by how the umbilical cord is cared for after delivery.

Five weeks after conception, the umbilical cord starts to develop. The umbilical cord is a tube like structure which links the growing baby to the placenta. The cord is a supply line as it carries the blood from the placenta to the baby. It nourished the newborn with nutrition and oxygen and also removes the baby’s waste products.

Some of the measures to take care of the newborn baby’s cord are:

  • Maintain a dry environment.
  • Allow it to breathe.
  • Give your infant sponge baths until the cord falls out (keeping the cord dry).

One of the initial standard medical interventions in labour was the early clamping of the cord. The WHO defines early cord clamping as the clamping the umbilical cord within the first 60 seconds of delivery. At the moment of birth, the infant is still connected to the mother through the umbilical cord. The cord is severed using two clamps: one positioned near the infant’s navel and the other further along the umbilical cord. Early clamping takes place during the third stage of labour i.e. the interval between childbirth and the placental delivery.

The goal of immediate umbilical cord clamping is to minimize respiratory depression in infants by transferring anaesthetic medicines from a mother to her baby. Early clamping and severing of the umbilical cord are a routine trend in labour management.

However, studies suggest that early cord clamping could be primary cause of anaemia in children. This prompted some researchers to promote late cord clamping as a low-cost strategy to prevent anaemia in the first six months of life. Blood continues to flow from the neonate to the placenta in the umbilical arteries for 20–25 seconds after childbirth. Placental transfusion persists in delayed umbilical cord clamping, and accounts for 1/4–1/3 of the infant blood volume.

The proven adverse effects of early clamping are

  • Hypovolemia of varying degrees- When accompanied by intrapartum cord compression, severe hypovolemia might occur
  • Hypoxia
  • Preload to the heart drops suddenly.
  • Increased afterload and peripheral vascular resistance due to blocked umbilical arteries
  • Decreased cerebral blood flow
  • Decreased cardiac output
  • Bradycardia

The increased risk of feto-maternal transfusion is also a possible drawback of early cord clamping.

Neonatal mortality associated with bacterial contamination of the umbilical cord may be one of the biggest public health challenges of the 21st century. Many studies have shown that early cord clamping does not particularly prevent postpartum haemorrhage. Hence, the WHO no longer recommends it as part of active treatment of the third stage of labour.

Despite the lack of evidence for the benefits of early cord clamping, the technique is still under practise for more than half a century. The practice has persisted for a variety of reasons, including convenience and a lack of awareness of the possible risks connected with quick cord clamping.

Author

Navya Koshi

Navya Mariam Koshi is a diligent, self-motivated Pharm D graduate using this platform to leverage her skills in this field to provide excellent and exceptional health care services to the public.

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