Photo courtesy to: Kate Kennedy (https://katekennedybirthphotography.com/) Photo courtesy to: Kate Kennedy (https://katekennedybirthphotography.com/)
Yesterday, December 21st, ACOG (the American College of Obstetricians and Gynecologists) started to recommend delayed cord clamping (for at least 30-60 seconds). This is an update from their earlier opinion from 2012. As a motive from changing their recommendation for term infants, the committee cites the Cochrane review from 2013, and our study on neurodevelopment published in JAMA Pediatrics 2015. They write: “At 4 years of age, children in the early umbilical cord clamping group had modestly lower scores in social and fine motor domains compared with the delayed umbilical cord clamping group”.
Of course we are very proud to have been able to provide research that has contributed to change the practice of umbilical cord clamping on term infants in US. Still, I believe that 30-60 seconds is too short time to wait, and we will be able to show evidence on this early in 2017.
The committees opinon follows (cited from http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Delayed-Umbilical-Cord-Clamping-After-Birth):
The American College of Obstetricians and Gynecologists’ Committee on Obstetric Practice makes the following recommendations regarding the timing of umbilical cord clamping after birth:
  • In term infants, delayed umbilical cord clamping increases hemoglobin levels at birth and improves iron stores in the first several months of life, which may have a favorable effect on developmental outcomes.
  • Delayed umbilical cord clamping is associated with significant neonatal benefits in preterm infants, including improved transitional circulation, better establishment of red blood cell volume, decreased need for blood transfusion, and lower incidence of necrotizing enterocolitis and intraventricular hemorrhage.
  • Given the benefits to most newborns and concordant with other professional organizations, the American College of Obstetricians and Gynecologists now recommends a delay in umbilical cord clamping in vigorous term and preterm infants for at least 30–60 seconds after birth.
  • There is a small increase in the incidence of jaundice that requires phototherapy in term infants undergoing delayed umbilical cord clamping. Consequently, obstetrician–gynecologists and other obstetric care providers adopting delayed umbilical cord clamping in term infants should ensure that mechanisms are in place to monitor and treat neonatal jaundice.
  • Delayed umbilical cord clamping does not increase the risk of postpartum hemorrhage.
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On this date, June 17, the paper 'Effect of timing of umbilical cord clamping on iron status in Mexican infants: a randomised controlled trial' by Camila M Chaparro, Lynnette M Neufeld, Gilberto Tena Alavez, Raúl Eguia-Líz Cedillo, and Kathryn G Dewey was published in Lancet 10 years ago.
For all of us that believes that delayed cord clamping is an important subject in term newborns, this study was and is very imortant. Ten years ago, it was larger and had a longer follow-up than the earlier studies, and it was also conducted in a rigorous manner scientifically. It also contributed a lot to the conclusions of the systematic reviews that were published the following years.
They ended the paper by writing: '… delayed clamping is an invaluable opportunity to increase an infant’s iron endowment at birth, thereby ensuring adequate iron status until other interventions can be more easily implemented.'
According to PubMed it has been cited in 262 other papers, thats some kind of achievement!

Happy anniversary!

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Yesterday I listened through a podcast on at pregnancypodcast.com about delayed cord clamping: pregnancypodcast.com/episode26/
Vanessa Merten, a mom and young professional, living in San Diego, CA, speaks in a very clear voice, has made good research and delivers a balanced information. I can really recommended it to everybody who wants to learn more about when to clamp the umbilical cord.

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Today I was interviewed by the Swedish newspaper Nerikes Allehanda. This was in conjunction with a symposia that was held during the Swedish annual spring meeting in perinatology. The symposia had speakers from the public and private stem cells banks, and me trying to explain our research findings, arguing to let the child keep it's own blood to avoid iron deficiency and improve later neurodevelopment.  http://na.se/nyheter/orebro/1.3767639-snabbtankt-och-handig-om-navelstrangen-far-sitta-kvar-ett-litet-tag

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The first private umbilical stem cell bank has recently been established in Sweden and has started discussions regarding the ethics of saving the babys blood for the future instead of letting it keep the blood for itself. Yesterday I was interviewed in Swedish television, stressing the points:
1. That the one deciliter blood that the baby loose, is equivalent to 2 liters of blood in an adult.  
2. Our research on Swedish healthy children has shown that waiting to clamp the cord for three minutes protects against iron deficiency at four months of age and improve fine motor function at four years of age.
3. Most official statements conclude, like the American College of Obstetricians and Gynecologists: "The routine storage of umbilical cord blood as “biologic insurance” against future disease is not recommended."
Here is the Swedish TV-clip: http://www.svt.se/nyheter/lokalt/vasternorrland/insamling-av-stamceller-riskerar-barns-halsa

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Photo: bigstock.com Photo: bigstock.com

My (first ever) editorial in a scientific paper was published only some days ago in Acta Pædiatrica: http://dx.doi.org/10.1111/apa.13261

I was of course thankful and honoured by the invite and quite nervous writing it :-).
The editorial is a comment on a study published at the same time by Lamberska & al: Premature infants born at less than 25 weeks of gestation may be compromised by currently recommended resuscitation techniques

In their conclusion, Lamberska et al. suggests that sustained inflation and delayed cord clamping may be effective alternatives when it comes to reducing the high mortality and morbidity among preterm infants born at the very earliest gestational ages.

Several techniques today that provides a less invasive management of the preterm transition and adaption to extra-uterine life, but they are only slowly adopted.

There's a dilemma in medicine, between providing a safe and evidence based care, and applying new approaches and techniques in a expedient way without unnecessary delay. In my own line of research, the slow adaption of delayed cord clamping is obvious, but this has been seen in many other fields, like for example transforming from resuscitation with 100 % oxygen to room air. 

The neonatal community, both regarding research and clinical work, stands before a great challenge: in not deferring the best treatment possible to our patients unnecessary long, without tampering on safety issues.

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Photo from bigstock.com Photo from bigstock.com

Dr. Chapas ObGynPearls have published a podcast called: Delayed vs. Immediate Umbilical Cord Clamping at Delivery 

It's a comprehensive review, although a  bit outdated as it uses data extrapolated from ACOG committee opinion from December 2012.

Dr. Chapas ObGynPearls is presented as "Evidence based lessons and factual clinical pearls to accompany the Texas A&M College of Medicine ObGyn Clerkship. Dr. Hector Chapa is a Board-Certified ObGyn who has published over 40 clinical studies. Additionally, Dr. Chapa has served as an FDA clinical trial investigator for a variety of gynecological medical devices. He currently serves as Clinical Assistant Professor in the Department of Obstetrics and Gynecology for the Texas A&M College of Medicine."


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Photo: Bigstock Photo: Bigstock

Usually experts discourage DCC when there is a blood group incompatibility between the mother and child, but this small study show benefits with DCC:
"decreased postnatal exchange transfusion needs, an improvement in the hemoglobin level at birth and longer delay between birth and first transfusion"
and no difference in jaundice or hyperbilirubinemia: "The maximum level of bilirubin, the rate of intensive phototherapy, and the total duration of phototherapy were similar in the 2 groups"

Garabedian C, Rakza T, Drumez E, et al. Benefits of Delayed Cord Clamping in Red Blood Cell Alloimmunization. Pediatrics. 2016;137(3):e20153236 DOI: 10.1542/peds.2015-3236

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