Recommendation Allows Mother To Hold Newborn Immediately After Birth Interview with:
Nestor E. Vain M.D.
Professor of Pediatrics, School of Medicine, University of Buenos Aires
Vice-President, FUNDASAMIN (Foundation for Maternal Infant Health), Argentina
Director, Neonatology, Hospital Sanatorio de la Trinidad Palermo and San Isidro,
Buenos Aires What is the background of this study?

Prof. Vain: Delayed umbilical cord clamping (DCC) is currently recommended by many professional associations. The main reason is that it decreases the incidence of iron deficiency in infancy, a very serious public health problem in developing countries, but also prevalent in the USA and in western Europe. Besides it has other advantages in premature infants such as better adaptation of the cardiovascular system to extra-uterine life. How does Delayed umbilical cord clamping work?. Approximately 30% of the fetal blood volume is in the placenta at the time of delivery. Waiting for a couple of minutes before clamping the cord allows for a large part of that blood volume to return to the infant. (this process is known as placental transfusion)

Despite of these well known facts, and the absence of serious complications, the compliance with the recommendation of delayed umbilical cord clamping is low. Why is that? There may be a variety of reasons but we are certain that one very important one is that the majority of obstetricians and neonatologists believe that to achieve an efficient placental transfusion and to avoid a negative effect from gravity, it is necessary to hold the infant at or below the level of the vagina during those 2 minutes. In that way the procedure is cumbersome and it prolongs unwillingly a separation between the infant and the mother. The believe that the infant needs to be at that low level is based on small studies performed more than 35 years ago.  What are the main findings of the study?

Prof. Vain: The main finding of our randomized controlled trial including 391 infants is that when the umbilical cord is clamped at 2 minutes, holding the infant on the mother’s abdomen or chest, even when mother is in a semi-sitting position makes no difference in the volume of placental transfusion compared to infants held at the level of the vagina. We measured the volume of placental transfusion in the following way: we got an initial weight in all infants immediately after birth with an electronic weight scale with its surface at the level of the vagina. Then half of the infants were held at the level of the vagina by an investigator and the other half were held by the mother on her abdomen or chest. In both groups we clamped the cord at 2 minutes and obtained a second weight using the same scale. Infants of both groups gained approximately 55g, which represents 50 cc of blood. The total blood volume of a 3 kg infant is approximately 250 cc.  Were any of the findings unexpected?

Prof. Vain: We had no real bias as what the findings will be. We suspected that the results would be that the volume of placental transfusion was going to be similar.  What should clinicians and patients take away from your report?

Prof. Vain: The most important measure is that the recommendation of delaying cord clamping can be respected by obstetricians and neonatologists while the infant is held by the mother on her abdomen or chest, therefore enhancing maternal infant bonding and facilitating the procedure. In this way the procedure may contribute to decrease anemia and delayed neurodevelopment associated with iron deficiency in infancy.  What recommendations do you have for future research as a result of this study?

Dr. Vain: We did not explore the effects of the position where the infant is held in premature newborns or infants born by cesarean section. Perhaps that can be studied in the future.

Effect of gravity on volume of placental transfusion: a multicentre, randomised, non-inferiority trial

Prof Nestor E Vain MD,Daniela S Satragno MD,Adriana N Gorenstein MD,Juan E Gordillo MD,Juan P Berazategui MD,M Guadalupe Alda MD,Prof Luis M Prudent MD
The Lancet – 17 April 2014
DOI: 10.1016/S0140-6736(14)60197-5

Last Updated on April 17, 2014 by Marie Benz MD FAAD