Guidelines for Optimal Umbilical Cord Clamping in Pediatric Newborn Medicine, Study notes of Medicine

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PEDIATRIC NEWBORN

MEDICINE CLINICAL

PRACTICE GUIDELINES

Optimal Umbilical Cord

Clamping

Clinical Guideline Name Optimal Umbilical Cord Clamping CWN Clinical Practice Manual Policy Number Implementation Date Due for CPC Review (^) 11/20 18 Contact Person Terri Gorman, MD Approved By (^) Dept of Pediatric Newborn Medicine Clinical Practice Council MSEC CWN SPP SPP Steering Nurse Executive Board/CNO Table of Contents Background

Route of delivery (vaginal vs. Caesarean, classical vs. low-transverse) Procedure:

1. Delivery of the baby (entire body) will be clearly announced by the senior obstetric provider present
2. Timekeeping will start (the obstetric nurse is the time keeper)
3. For vaginal deliveries the baby should be placed on the maternal lower abdomen and covered with a warm blanket. For cesarean deliveries the baby should be placed on the upper legs or the abdomen above the incision at Caesarean delivery (at the obstetrician’s judgment). The infant will not be held up for parental viewing until after the cord has been clamped to ensure blood flow toward rather than away from the infant.
4. No milking or stripping of the cord should be performed.
5. The obstetric nurse verbally reports when 60 seconds have elapsed.
6. Cord clamp is then applied, the umbilical cord is cut, and the infant is given to the mother or to the pediatric team if indicated. Immediate clamping criteria Per the discretion of the obstetrician If the pediatrician desires the optimal cord clamping to be discontinued, they will clearl y communicate to the attending obstetrician, “Do you think there is a need for pediatric assessment?” Unless there is a disagreement on behalf of the obstetrician, immediate cord clamping should be instituted at this prompt. If there is disagreement, the pediatrician should be invited for bedside assessment. Post-clamping procedure Postpartum uterotonics should be administered by the obstetrical team as per routine The time to cord clamping should be recorded in the mother’s medical record by the delivering obstetrical provider Procedure for collection of umbilical cord blood samples Including umbilical cord blood gases, genetic samples, umbilical cord banking, etc. Collect directly from the cord following clamping at the discretion of delivering Obstetrical Provider

Responsibility Action Obstetrical Provider Deliver the baby, announce occurrence of delivery to the obstetric nurse, wrap in warm blanket provided by nursing, gentle stimulation and bulb suction if needed. Hold baby on the mother. Clamp and cut cord at least 60 seconds after delivery and give infant to mother or to the Pediatric team as appropriate. Perform immediate cord clamping if deemed necessary. NICU or OB Nurse (^) Have a warm sterile blanket ready for OB team. Announce time at 30, 45 , and 60 seconds following delivery. Note time of umbilical cord clamping and record it in the chart. Neonatal Physician/NNP Receive infant from delivering OB following cord clamping. Assess Apgar scores at 60 seconds after birth in concert with the obstetrical provider. Proceed with standard neonatal stabilization or resuscitation. References:

1. Mercer JS, Vohr BR, McGrath MM, Padbury JF, Wallach M, Oh W. Delayed cord clamping in very preterm infants reduces the incidence of intraventricular hemorrhage and late-onset sepsis: a randomized, controlled trial. Pediatrics 2006; 117:1235.
2. Rabe H, Diaz-Rossello JL, Duley L, Dowswell T. Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes. Cochrane Review 2012, Issue 8.
3. McDonald SJ, Middleton P. Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. Cochrane Review 2009, Issue 3.
4. Aladangady N, McHugh S, Aitchison TC, Wardrop CAJ, Holland BM. Infants’ blood volume in a controlled trial of placental transfusion at preterm delivery. Pediatrics 2006; 117:93-99.
5. Baenziger O, Stokin F, Keel M, et al. The influence of the timing of cord clamping on postnatal cerebral oxygenation in preterm neonates: a randomized, controlled trial. Pediatrics 2007; 119:4 55 - 460.
6. Kinmond S, Aitchison TC, Holland BM, Jones JG, Turner TL, Wardrop CAJ. Umbilical cord clamping and preterm infants: a randomized. BMJ 1993; 306:172-175.
7. Kugelman A, Borenstein-Levin L, Kessel A, Riskin A, Toubi E, Bader D. Immunologic and infectious consequences of immediate versus delayed umbilical cord clamping in premature infants: a prospective, randomized, controlled study. J Perinat Med 2009; 37:281-87.
8. Mercer JS, Vohr BR, Erikson-Owens DA, Padbury JF, Oh W. Seven month developmental outcomes of very low birth weight infants enrolled in a randomized controlled trial of delayed versus immediate cord clamping. J Perinatol 2010; 30(1):11- 16
9. Rabe J, Wacker A, Hulskamp G, et al. A randomized controlled trial of delayed cord clamping in very low birth weight preterm infants. Eur J Pediatr 2000; 159:775-777.
10. Ceriani JM, Carroli G, Pellegrini L, et al. The effect of timing of cord clamping on neonatal venous hematocrit value and clinical outcome at term: a randomized controlled trial. Pediatrics 2006; 117:e779-86.
11. Delayed umbilical cord clamping after birth. Committee Opinion No. 684. American College of Obstetricians and Gynecologists. Obstet Gynecol 2017;129:35-10.
12. Textbook of Neonatal Resuscitation (NRP), 7th^ Edition. p.49-50.
13. Guidelines for Perinatal Care, 8th^ Edition. p.269-270.