Early versus Delayed Umbilical Cord Clamping Leads to Neonatal Anemia

Objective: To evaluate whether Early Cord Clamping (ECC) leads to anemia and Delayed Cord Clamping (DCC) could improve the haematological status of infants. Patients and Methods: Interventional randomized trial study was carried out over a period of six months from 1st October, 2010 to 31st March 2011 in Gynecology Department Lady Willingdon Hospital, Lahore. A detailed questionnaire was prepared. Total 300 cases were randomly allocated after taking informed consent. Venous hematocrit values, Bilirubin levels and ferritin were detected after 24 hours, 48 hours and 3 months of neonatal life and the record entered into proforma. Results: Neonatal anemia and decreased hematocrit level was found in 32 / 150 (21%) neonates with greatest significance due to early cord clamping neonatal. While Delayed cord clamping (DCC) resulted with a higher mean hematocrit (45.6 ± 5.6 versus 32.8 ± 7.1 at the end of three months) and hemoglobin concentration (17.4 ± 2.2 g/dL vs 12.5 ± 4.1 g/dL at the end of 3 months), whilst a non-significant difference was observed in mean bilirubin level in DCC group as compared to ECC group (7 ± 2.3 vs 5 ± 3.5 mg/dL in 48 hours). A significant number of infants developed jaundice in DCC group as compared to ECC groups (8% vs 2%; p = 0.016). No infants polycythemia, mother postpartum hemoorhage was seen in both groups. All the jaundice patients recovered with Phototherapy. Conclusion: To get the normal hematocrit level in term infants, it is very necessary to avoid early cord clamping and this practice should be changed in modern obstetrical practice as it is not the standard method and the cause of iron deficiency anemia. Delayed cord clamping method increases mean neonatal hematocrit, hemoglobins within a physiologic range and save from developing iron deficiency anaemia although delaying clamping increases the risk of jaundice requiring phototherapy.