The Effect Of Timing Of Cord Clamping On Neonatal Haemoglobin And Haematocrit Values At Term: A Randomized Control Trial.

Abstract

Background: The umbilical cord is usually clamped immediately after birth. There is no sound evidence to support this approach, which might deprive the newborn of benefits such as an increase in iron storage during the neonatal period. The negative effects of this are more profound in lower socioeconomic groups. Objective: To determine the effect of timing of umbilical cord clamping on haemoglobin and haematocrit level of term newborns. Methodology: This was to be a randomized controlled trial that included 96 mother-neonate pairs at term who met the selection criteria, 48 in the delayed cord clamping group (>120seconds) and 48 in the immediate cord-clamping group (<30 seconds). Setting: Kenyatta National Hospital, Labour ward, Nairobi, Kenya. Populations: Full term newborns undergoing spontaneous vertex delivery of low risk pregnancy mothers. Variables: Primary dependent variables the infants’ venous haemoglobin and haematocrit value measured between 6-24 hours after birth. Secondary dependent variables included early respiratory distress symptoms, neonatal jaundice that necessitated for phototherapy and polycythemia. Independent variables: Socio-demographic and medical characteristics of the mothers. Analysis plan: Levels of haemoglobin and haematocrit of newborn infants following delayed umbilical cord clamping were compared to those of newborns who undergo immediate cord clamping using unpaired students T- test and a P value <0.05 (<0.025 at interim analysis) for significance. Multiple linear regressions were done to analyze maternal characteristics as confounding factors to neonatal haemoglobin and haematocrit values. Results: The mean haemoglobin level in the DCC group was 17.19g/dL and 15.63g/dL in the ICC group, a mean difference of 1.56g/dL. The mean haematocrit levels in the DCC and ICC groups were 53.44% and 47.63% respectively, a mean difference of 5.81%. A statistically significant difference in both Hb and Hct (P value <0.001). There was no significance of maternal characteristics on neonatal Hb and Hct values. Haemoglobin in neonates that underwent DCC did not depend on the mother’s haemoglobin, however among the neonates that underwent ICC, the haemoglobin level appeared to increase gradually with increase in the mother’s haemoglobin, and thus ICC is more detrimental in a population that suffers from anaemia. Conclusion: DCC is an easy procedure that can be incorporated into AMSTL as it leads to increased levels of Hb and Hct levels in the neonates and thus reducing complications that occur secondary to anemia in early childhood, especially in resource limited settings.