The Impact of Early Versus Delayed Cord Clamping on Neonatal outcomes: A comparative study
DOI:
https://doi.org/10.31530/cjnst.2025.1.1.5Keywords:
maternal and neonatal factors, cord clamping time, resuscitation,, APGAR scoresAbstract
Background: The timing of umbilical cord clamping has been widely debated in obstetrics. An early cord clamping (ECC) was adopted widely since the 20th century; however, accumulating data over the past two decades has challenged this practice and considered delayed cord clamping (DCC) as the best practice with optimized neonatal outcomes.
Aims: To investigate the impact of ECC vs. DCC on APGAR score in neonates at one and 5-minutes after delivery and to investigate the relationship between the timing of cord clamping and the need for neonatal resuscitation or other immediate postnatal care.
Methodology: In this clinical comparative study, 500 participants were randomly and equally allocated into two groups at Erbil Maternity Teaching Hospital, Erbil, Kurdistan Region, Iraq, from May 2024 to January 2025. Group one (n=250), in which the ECC was performed within 30 seconds after birth without milking the umbilical cord, and Group two (n=250), in which the DCC was performed at 1.5 minute, with milking the umbilical cord once only. Then, patients sociodemographic and clinical data were obtained, and the APGAR score was assessed at one and 5-minutes post-delivery for both groups.
Results: The mean maternal age was 30.6 ± 3.5, while their mean gestational age was 37.6 ± 1.2 weeks. The mean neonates’ BW was 3.14 ± 0.45 kg, with nearly equal gender distribution, and most of them (28.4%) had an APGAR score of 9 after one minute, while majority (29.4%) had APGAR score of 10 after 5-minutes. Also, most neonates had no SOB (59.2%), while 40.8% were admitted to Neonatal Intensive Care Unit (NICU) due to grunting (18.8%) and asphyxia (4.44%). No significant associations (p>0.05) were observed between neonatal/maternal factors and the time of clamping. APGAR score at one and 5-minutes also not significantly (p>0.05) correlated with the time of clamping. Regression analysis revealed that the DCC predict higher APGAR scores at one and 5-minutes. Also, neonates in the DCC group demonstrated 67% reduced odds of APGAR score of ≤7.
Conclusion: DCC improves neonatal adaption reflected by higher APGAR scores, that supports its adoption as routine practice during term deliveries.
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