The new research, led by the University of Sydney, is a two-year follow up of the Australian Placental Transfusion 高清福利片, the award-winning and largest-ever clinical trial of delayed cord clamping of babies born before 30 weeks. It was conducted in 25 hospitals across seven countries.
The new study compared outcomes for over 1500 babies from the initial study, 767 with caregivers aiming for 60 second delay in clamping and 764 with caregivers aiming for cord clamping before 10 seconds after delivery.
Researchers found that delaying clamping reduces a child鈥檚 relative risk of death or major disability in early childhood by 17 percent. This included a 30 percent reduction in mortality before the age of two.
In addition, 15 percent fewer infants in the delayed-clamping group needed blood transfusions after birth.
The study is published in today.
It is coordinated by the University of Sydney鈥檚 in collaboration with the IMPACT Clinical Trials Network of the Perinatal Society of Australia and New Zealand and the Australian and New Zealand Neonatal Network.
Professor William Tarnow-Mordi
高清福利片 lead, Professor William Tarnow-Mordi, Head of Neonatal and Perinatal Trials at the Clinical Trials Centre and Professor of Neonatal Medicine in the Faculty of Medicine and Health said the simple process of aiming to wait a minute before clamping will have significant impact worldwide.
鈥淚t鈥檚 very rare to find an intervention with this sort of impact that is free and requires nothing more sophisticated than a clock. This could significantly contribute to the to end preventable deaths in newborns and children under five - a goal which has really suffered during the pandemic,鈥 he said.
Dr Kristy Robledo
鈥淎pplied consistently worldwide, aiming to wait a minute before cord clamping in very preterm babies who do not require immediate resuscitation could ensure that an extra 50,000 survive without major disability in the next decade,鈥 said biostatistician from the University of Sydney who led the two-year follow-up analysis.
鈥淚n other words, for every 20 very preterm babies who get delayed instead of immediate clamping, one more will survive without major disability.鈥
Delayed umbilical cord clamping is routine in full term babies to allow the newborn time to adapt to life outside the womb, however, until recently, clinicians generally cut the cord of preterm babies immediately so urgent medical care could be given.
鈥淭en years ago, umbilical cords were routinely clamped quickly after a very preterm birth and the baby was passed to a paediatrician in case the child needed urgent help with breathing,鈥 said Professor Tarnow-Mordi.
鈥淏ut we now know that almost all very preterm babies will start breathing by themselves in the first minute, if they are given that time.鈥
鈥淲e think that, after delaying cord clamping, babies get extra red and white blood cells and stem cells from the placenta, helping to achieve healthy oxygen levels, control infection and repair injured tissue.鈥
For every 20 very preterm babies who get delayed instead of immediate clamping, one more will survive without major disability.
The childhood follow-up to the is the largest world-wide two-year follow up of pre-term cord clamping providing the best evidence to date on positive outcomes at two years of age.
Co-author and founder of Miracle Babies Foundation , herself a parent of three pre-term babies, said she hoped the results would give parents confidence to discuss their options with their birthing professionals.
鈥淚 hope that prospective parents around the world will read about this trial for themselves and discuss it with their midwives and obstetricians,鈥 she said.聽
The first evidence from this group, published in the聽, indicating that delayed umbilical cord clamping might have benefits for preterm infants and their mothers came in 2017 from a systematic review of randomised trials in nearly 3,000 preterm babies.聽
The 聽led by Professor Tarnow-Mordi was the largest of these trials and went on to be named winner of the 'Trial of the Year' by Federal Health Minister, Greg Hunt MP and the Australian Clinical Trials Alliance in 2018.
While the World Health Organization recommends that newborns, including preterm babies who do not require positive pressure ventilation should not have their cord clamped earlier than one minute after birth this has not always been consistently applied.
鈥淢idwives welcome this research - delaying cord clamping ensures that the physiological changes happening at the time of birth can happen and there are clearly very good outcomes especially for premature babies. We can all do this and now we know we should,鈥 said President of the Perinatal Society of Australia and New Zealand and past President of the Australian College of Midwives.
鈥淢oving forward it鈥檚 vital that perinatal professionals record the time of first breath and cord clamping to the second during births to allow for robust, large-scale data to further our work in this area,鈥 said co-author Professor Jonathan Morris, Professor聽of Obstetrics and Gynaecology at the University of Sydney and Director, Women and Babies Research at
鈥淚ntensive staff training in the new protocols will also be vital as it can be daunting to delay treatment in very early and sick babies but the evidence suggests this results in the best outcomes for these children.鈥
The (Advancing Large collectively Prioritised trials for Health outcomes Assessment) will be vital to taking this research forward. They are an international collaboration of perinatal researchers, professionals, parents and policymakers that work with organisations and individuals worldwide to ensure that trials like this can, in the future, run at least ten times larger and faster, in a new era of increased international collaboration.
Information for parents: Parents who want to know more are encouraged to visit the NHMRC Clinical Trials Centre website at聽聽 or Miracle Babies Foundation at聽聽for frequently asked questions about the Australian Placental Transfusion 高清福利片.聽
Parents in Australia who need support can contact Miracle Babies Foundation 24-hour helpline at 1300 622 243.
Declaration: This trial is registered with the Australian and New Zealand Clinical Trials Registry: . The authors declare no competing interests. The research is supported by grants from the National Health and Medical Research Council, Australia. (NHMRC GNT 571309, NHMRC GNT 1086865)