▎ WuXi AppTec content team editor
Globally, about 1 million babies are born before 30 weeks of pregnancy each year. Very preterm babies face a higher risk of disability and death in early childhood. And at the time of their birth, a simple action will help change their healthy destiny.
As soon as the baby is born, the doctor will clamp the umbilical cord with hemostatic forceps and cut the umbilical cord from the middle. The timing of the cord clamping is a key factor.
Usually, in term infants, delayed cord clamping is chosen to give the newborn time to adapt to the extrauterine environment. But for premature babies, there has long been controversy, with one view that immediately cutting off the umbilical cord of premature babies is conducive to providing emergency medical care as quickly as possible.
Image credit: 123RF
Recently, The Lancet Child and Adolescent Health recently published a global large randomized clinical trial, the results show that for babies born less than 30 weeks pregnant, delay 1 minute for umbilical cord clamping, these premature babies within 2 years of age will significantly reduce the risk of death by 3%.
The paper states, "These findings provide the first definitive evidence that intervention at the time of delivery improves 2-year disability-free survival rates (in very preterm infants)." It also supports the World Health Organization's recommendation that for newborns or premature babies that do not require positive pressure ventilation, the umbilical cord should not be clamped within 1 minute of birth. ”
Screenshot source: The Lancet Child and Adolescent Health
The study, called APTS (Australian Placental Transfusion Study), was led by academics at the University of Sydney and conducted at 25 clinical centres in 7 countries around the world.
Between 21 October 2009 and 6 January 2017, a total of 1531 families of preterm infants (less than 30 weeks pregnant at birth) agreed to follow up, of which 767 infants were randomly grouped at birth to receive delayed (at least 1 minute) cord clamping and 764 were randomized to receive immediate (within 10 seconds) cord clamping.
Both groups actually received treatment in 74% (564/767) and 96% (726/764) infants in each group who followed the trial protocol exactly.
Outcomes of death or severe disability up to 2 years of age were identified in 1419 infants (93%), with death or severe disability occurring in 29% of the delayed clamping group (204/709) and 34% (240/710) of the immediate clamping group.
Delayed clamp significantly reduced the risk of death or severe disability in very preterm infants by 17% (0.83, 95% CI 0.72–0.95) after adjusting for pregnancy factors, sex, birth weight, multiple birth status, and mode of delivery.
Look at the indicators further:
The risk of death was significantly reduced by 30% at 2 years of age in the delayed clamping group (RR 0.70, 95% CI 0.52–0.95). Infants in the delayed clamping group 8% (60/725) and 11% (81/720) in the immediate clamping group died within 2 years of age (RR 0.70, 95% CI 0.52–0.95).
Among the surviving infants, there was no significant difference in the risk of severe disability between the two groups. 23% (144/627) of the delayed clamping group and 26% (159/603) of the immediate clamping group developed severe disability before the age of 2 years (RR 0.88, 0.74-1.04).
In addition, infants in the delayed clamp group had a 15% lower risk of needing blood transfusions after birth.
"Ten years ago, premature babies would be quickly clamped on the umbilical cord and then handed over to a pediatrician in case the baby needed urgent breathing assistance." Professor William O Tarnow-Mordi of the University of Sydney, who led the study, said, "But we now know that if given time, almost all premature babies will start breathing on their own within 1 minute of birth. We believe that after delayed cord clamping, infants can get extra red blood cells, white blood cells, and stem cells from the placenta, which helps to reach healthy oxygen levels, control infection, and repair injured tissue. ”