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The Centers for Disease Control and Prevention (CDC) highlights preterm birth as one of the majors causes of infant mortality in the United States, second in the rankings only to birth defects.1 Accordingly, significant clinical, investigative and political efforts are dedicated to defining practices that can optimize outcomes in preterm infants. One such practice – delayed cord clamping (DCC) – has been endorsed by major medical societies including the American Academy of Pediatrics (AAP), the American College of Obstetricians and Gynecologists (ACOG) and the Neonatal Resuscitation Program (NRP) as a protective strategy during delivery of premature infants. DCC involves deferring the clamping of the umbilical cord for 30 to 60 seconds after birth to permit extended blood flow from the placenta to the infant, purportedly decreasing the need for blood transfusions and associated complications.

Investigators at the University of Maryland Medical Center (UMMC) recently conducted an analysis exploring the relationship between DCC and transfusion requirement in very low birth weight infants (VLBW). Led by Dr. Sripriya Sundararajan – medical director of the neonatal intensive care unit and associate professor of pediatrics at UMMC – the study explored the rates of blood transfusions amongst 538 very low birth weight infants delivered at the center between 2016 and 2020. Other outcomes explored included neonatal sepsis, retinopathy of prematurity, necrotizing enterocolitis and intraventricular hemorrhage.

Results from this UMMC study were recently published in the American Journal of Perinatology. Delayed cord clamping significantly reduced the need for RBC transfusions at any gestational age and had a significant positive impact on the transfusion burden.

Notable findings include:

  1. There was a significant decrease in the proportion of infants with DCC that required RBC transfusion. (33 [9.9%] vs. 48 [23.3%], p<0.001).
  2. Based on linear regression analysis, at any given GA, the number of transfusions that the neonates received was 25% lower in the neonates that received DCC compared with infants without DCC.
  3. In this analysis, receiving a blood transfusion was associated with increased risk for bronchopulmonary dysplasia and persistent ductus arteriosus.

In the wake of these findings, Dr. Sundararajan emphasizes her support for DCC, saying, "Delayed cord clamping (DCC) is a very effective, yet simple, safe and no-cost feasible intervention that saves lives through placental transfusion and has proven benefits especially in the preterm population. The continuing high rates of RBC transfusion in preterm infants lesser than 28 weeks gestation may reflect the ongoing hesitancy in adopting the practice of DCC at delivery in lower gestational ages. The fear of delay in the timely resuscitation in ELBW population must be addressed while promoting a safe delivery room management practice of DCC and incorporate placental transfusion in eligible preterm infants."

This and other recent studies with similar findings will further bolster the evidence base behind delayed cord clamping and likely contribute to improving uptake of this life saving intervention.

At UMMC, Dr. Sundararajan and her team have successfully incorporated DCC into their clinical protocols as part of a standardized set of guidelines for blood product use in the NICU. Plans are in place to explore the feasibility of neonatal resuscitation during DCC.

  1. Seidler AL, Libesman S, Hunter KE, Barba A, Aberoumand M, Williams JG, Shrestha N, Aagerup J, Sotiropoulos JX, Montgomery AA, Gyte GML, Duley L, Askie LM; iCOMP Collaborators. Short, medium, and long deferral of umbilical cord clamping compared with umbilical cord milking and immediate clamping at preterm birth: a systematic review and network meta-analysis with individual participant data. Lancet. 2023 Dec 9;402(10418):2223-2234. doi: 10.1016/S0140-6736(23)02469-8. Epub 2023 Nov 14. Erratum in: Lancet. 2023 Dec 9;402(10418):2196. PMID: 37977170.

Learn more about Neonatology at the University of Maryland Medical Center.

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