Delayed cord clamping for the new-born in need of neonatal resuscitation

Organization: 
Patan Academy of Health Sciences, Uppsala University
Organization Location: 
Lalitpur, Nepal and Uppsala, Sweden

Robust evidence shows that delayed cord clamping (DCC) of a vigorous child after birth is superior for neonatal health compared to early clamping. The benefit in low-income settings is even more evident given the limited resources available for postpartum care. DCC will allow for a prolonged transfusion of blood from mother to child resulting in a lower rate of neonatal anemia, serious neonatal infection, and brain hemorrhage, and also a better iron supply during early infancy. However, when the infant does not breathe spontaneously after birth, standard management in all settings has been to clamp the cord early and move the child to an area where resuscitation is feasible. Given that insufficient blood volume is assumed to reduce the chance of a successful resuscitation, the extra blood volume of up to 30 % transfused from the mother during DCC could provide a better outcome. We intend to conduct a randomized, controlled trial of DCC for infants subject to neonatal resuscitation at a maternal facility of Kathmandu, Nepal. The intervention group will be resuscitated according to regular hospital protocol, but on the abdomen of the mother with the cord intact until pulsations cease. This practice has not been tried for reduced neonatal mortality in a clinical trial before. If proven successful, this would be a simple and low-cost intervention with the ability to be scaled up in both facility and community settings.

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