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What is Delayed Cord Clamping
to Delayed Cord
After a baby is born, the umbilical cord is clamped and cut. This may be done immediately after birth or it can be delayed, and different groups have different opinions on how long to wait. Delayed clamping allows some of the blood in the umbilical cord and placenta to flow back into the baby. Some groups believe in waiting for the cord to stop pulsating before the cord is clamped and cut. However studies show that most of the blood transfer from the umbilical cord to the baby occurs in the first 60 seconds.1 Medical professionals consider delayed cord clamping to be waiting 30 seconds or more after the birth.
What do professionals say about Delayed Cord Clamping
The American College of Obstetricians and Gynecologists (ACOG) recommends 30-60 second DCC in premature babies born before 34 weeks pregnancy, based on clinical evidence that it reduces complications associated with prematurity2. The World Health Organization (WHO) recommends 60 second DCC for all babies, to compensate for varying levels of nutrition around the world3. In January 2017, ACOG started to recommend 30-60 second DCC for full term babies4. The immediate benefits of DCC for these babies are increases in blood volume and iron levels, while the long term benefits are still under investigation5. Parents should discuss their birth plan with their healthcare provider and whether DCC will be a part of that plan.
Can I have delayed cord clamping and still bank cord blood?
Delayed cord clamping will decrease the amount of blood that remains in the umbilical cord6, but it is still possible to collect and bank that cord blood. There is enormous variation from one baby to another in the length of the umbilical cord, the size of the placenta, and the amount of cord blood7. Some babies can easily have DCC and still have plenty of cord blood for banking, whereas others may have little cord blood left after DCC. Unfortunately, parents will not know in advance how much cord blood their baby has when deciding whether to plan for DCC.
How do I combine delayed cord clamping with cord blood donation?
When parents deliver at a hospital that accepts cord blood donations for public transplants, they should ask if the hospital has any policy on DCC. Due to the need for high stem cell counts in current transplant procedures, the percentage of cord blood collections that qualify for storage in public banks is low. When DCC is added, the percentage of collections that qualify for storage decreases as the length of the delay increases6. For this reason, parents should be aware that DCC may prevent their cord blood donation from meeting donation thresholds.
How do I combine delayed cord clamping with family cord blood banking?
While it is true that family banks will store small cord blood collections, parents should know that bigger cord blood collections are likely to be better for most therapeutic needs. Parents must weigh their individual priorities. Those families with an older child in need of stem cell therapy would likely make it a priority to obtain a transplant-quality cord blood collection and prioritize this over DCC. Other families with a full-term baby and no foreseeable need for stem cells may decide that the benefits of DCC outweigh the desire to store stem cells for future therapy. In summary, it is possible to have DCC and still preserve cord blood stem cells.
Should I still consider Cord Blood Banking
If my baby is premature, should I still consider cord blood banking?
Yes, both delayed cord clamping and cord blood banking have heightened importance for premature babies. On the one hand, DCC has clear benefits in preventing complications for infants born before 34 weeks of pregnancy2. On the other hand, premature babies have an elevated risk of cerebral palsy8, and clinical trials are underway evaluating the potential of cord blood as a treatment for this and related conditions. Research has shown that the concentration of stem cells is higher in the cord blood of premature babies9, so even a small amount of cord blood collected from these babies can be of therapeutic value.
What is the optimum delayed cord clamping time for parents choosing to bank cord blood?
The optimal DCC time is a topic of ongoing research5. The delay should be long enough to allow some of the blood in the umbilical cord to flow into the baby, but not so long that it is no longer possible to collect cord blood.
Studies suggest that the minimum delay of 30 seconds will accomplish both goals for most newborns1,5,6. It is important for parents to develop an individual plan with their healthcare provider, taking into account their known pregnancy complications, their risk of premature delivery, and any need to save cord blood for sibling therapy.
- Linderkamp Acta Paediatr. 1992; 81(10):745-50.
- ACOG Committee Opinion No.543, Dec. 2012, Timing of Umbilical Cord Clamping after Birth.
- WHO Guideline: Delayed Umbilical Cord Clamping.
- ACOG Committee Opinion, No.684, Jan. 2017, Delayed Umbilical Cord Clamping After Birth.
- Semple 2016.
- Allan et al. Transfusion. Mar 2016; 56(3):662-5.
- Nakagawa R et al, Transfusion 2004; 44:262-7.
- van Haastert et al. Pediatrics 2011; 159(1):86-91.
- Falcon-Girard et al. 2013; Cytotherapy 15(4): S21.