CORD CLAMPING OF THE NEONATE

On the issue as to how soon after delivery to clamp and cut the umbilical cord:

• Arguments in favor of doing so promptly after delivery (i.e. within seconds) include avoidance of jaundice and respiratory distress from excess RBC mass and intravascular volume
• Arguments in favor of doing so after a pause (i.e. after cessation of palpable pulsations of the umbilical cord, or at 3 minutes) include avoidance of neonatal hypovolemia and iron loss

In a systematic review of 8 randomized and 7 nonrandomized studies, late-clamped, as compared with early-clamped neonates, had:

• Higher HCT at hours-days after delivery but no sig. diff. at 6mos
• No sig. diff. in mean bilirubin levels or risk of jaundice during the neonatal period, or of tachypnea or respiratory distress, or NICU admission
• Higher ferritin levels and iron stores
• Lower risk of anemia at 24-48h and 2-3mos of age
• Higher risk of polycythemia within the first few days of life

(JAMA 297:1241, 2007--AFP)