Literature Reviewed Databases- Joanna Briggs Institute, Cochrane Library,

PubMed, and EBSCOhost

Keywords used– neonates, cord clamping, anemia, “late

vs. early”, “late vs. early cord clamping”, and immediate

cord clamping vs. delayed cord clamping

Year limits– 2007 to 2014, one article outside range: 2003

Other search limits– systematic review

Number of articles reviewed– 28 articles were reviewed,

9 were selected to be used

Considerations Units- Labor and Delivery and free standing

birthing clinics (Chaparro, 2011)

Clients- Stable mothers and newborns

Cost- No cost involved

Education- Staff to be educated on procedure

and significance

Feasibility- An extra 2-3 minutes with client,

very feasible, some institutions feel that this

time slows room recovery process

Transferability – Cannot be used in acute care

settings without laboring women

Recommendations for Practice Delayed cord clamping should be considered standard of care for full term deliveries after uncomplicated

pregnancies (Anderson et al., 2011)

No negative effects on the mother

Only an extra 2-3 minutes in the room (Chaparro, 2011)

No significant costs

“Further studies are needed to explore long term health effects of delayed and early cord clamping.” (Anderson

et al., 2011, p. 6)

Summary of Evidence

In all studies, delaying cord clamping 2 to 3 minutes was shown

to improve hematocrit levels, hemoglobin concentration, ferritin

concentration, and reduced the risk of infant anemia

Delayed cord clamping improved tissue oxygenation in infants

after 4 hours and 24 hours

Delaying cord clamping by 2 to 3 minutes in a full term infant al-

lows about 25 to 35 ml of blood per kg of body weight to be de-

livered through placental transfusion. This would provide 46-60

mg of iron to the infant.

Preterm babies faced less complications such as transfusions, ane-

mia, sepsis, and intravascular hemorrhage as a result of delayed

cord clamping

Infants who had delayed cord clamping have a lower anemia sta-

tus and have an average of 0.89 g/dl more hemoglobin than early

clamped babies

All of these results and benefits last until at least 6 months of age

Encouragement for change has come from more neonatal and

pediatric departments rather than obstetrics

No undesirable effects were found from delaying cord clamping

A cost free method of reducing anemia

References Andersson, O., Hellström-Westas, L., Andersson, D., & Domellöf, M. (2011). Effect of delayed versus early umbilical cord clamping on neonatal outcomes and iron status at 4

months: A randomised controlled trial. BMJ: British Medical Journal (Overseas & Retired Doctors Edition), 343(7836), 1244-1244. http://dx.doi.org/10.1136/bmj.d7157

Chaparro, C. M. (2011). Timing of umbilical cord clamping: Effect on iron endowment of the newborn and later iron status. Nutrition Reviews, 69, S30-S36. http://d

x.doi.org/10.1111/j.1753-4887.2011.00430.x

Grajeda, R., Perez-Escamilla, R., & Dewey, K. G. (1997). Delayed clamping of the umbilical cord improves hematologic status of Guatemalan infants at 2 mo of age. American J

ournal of Clinical Nutrition, 65(2), 425-431. Retrieved from http://0-search.ebscohost.com.alvin.iii.com/login.aspx?direct=true&db=c8h&AN=1997012210&scope=site

Gyorkos, T. W., Maheu-Giroux, M., Blouin, B., Creed-Kanashiro, H., Casapía, M., Aguilar, E., Penny, M. E. (2012). A hospital policy change toward delayed cord clamping is

effective in improving hemoglobin levels and anemia status of 8-month-old Peruvian infants. Journal of Tropical Pediatrics, 58(6), 435-440. Retrieved from http://0-

search.ebscohost.com.alvin.iii.com/login.aspx?direct=true&db=aph&AN=83932074&scope=site

Hutchon, D. J. R. (2012). Immediate or early cord clamping vs delayed clamping. Journal of Obstetrics & Gynecology, 32(8), 724-729. http://

dx.doi.org/10.3109/01443615.2012.721030

Hutton, E. K., & Hassan, E. S. (2007). Late vs early clamping of the umbilical cord in full-term neonates: Systematic review and meta-analysis of controlled trials. JAMA: Jour

nal of the American Medical Association, 297(11), 1241-1252. Retrieved from http://0-search.ebscohost.com.alvin.iii.com/login.aspx?

irect=true&db=c8h&AN=2009541047&scope=site

Sommers, R., Stonestreet, B., Oh, W., Laptook, A., Yanowitz, T. D., Raker, C., Mercer, J. (2012). Hemodynamic effects of delayed cord clamping in premature infants. Ameri

can Academy of Pediatrics, 129(3), 667-672. Http://dx.doi.org/10.1542/peds.2011-2550

Tillett, J. (2013). Cord Clamping: What Is the Best Practice? Journal of Perinatal and Neonatal Nursing, 27(3), 197-198. http://dx.doi.org/10.1097/JPN.0b013e31829b26a9

Ultee, C. A., van, d. D., Swart, J., Lasham, C., & van Baar, A. L. (2008). Delayed cord clamping in preterm infants delivered at 34-36 weeks' gestation: A randomised controlled

trial. Archives of Disease in Childhood -- Fetal & Neonatal Edition, 93(1), F20-F23. http://dx.doi.org/10.1136/adc.2006.100354

Late vs. early cord clamping effects on anemia

Kathryn Shaner, Allison Blackburn, Ashley Epprecht, and Meredith Bassler

Significance Iron is important for growth and development

Breastfed infants do not receive enough iron from breast milk

Timing of umbilical cord clamping has a large impact on iron stores

Early cord clamping, within 10-15 seconds, may deprive the infant of additional

iron stores (Chaparro, 2011)

Late cord clamping, 2-3 minutes after delivery, allows enhances iron stores

(Chaparro, 2011)

Timing can alter hematological status for the first six months of life

Current Practice Early cord clamping has been protocol for the past two decades (Chaparro, 2011)

Many believe its prevents hemorrhage, hyperbilirubinemia, and polycythemia (Chaparro, 2011)

No evidence to support this

Early clamping is used to be able to move the mother and baby out of the delivery room faster

In 2007, WHO removed early cord clamping from their recommendations for the third stage of

labor (Chaparro, 2011)

Organizations are working towards educating practitioners on the positive effects of delayed cord

clamping, in hopes of changing the current practice.