1. 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.