Friday, November 17, 2017

Just wait a minute, and you save thousands of preterm babies a year

babycenter.com
   
November 17 is celebrated as World Prematurity Day and theme for this year is ‘let them thrive.’

According to WHO An estimated 15 million babies are born preterm every year – more than 1 in 10 babies around the world and this number is rising. Preterm birth complications are the leading cause of death for children under 5.

Well, the obstetricians and health care personal assisting in child birth could save thousands of lives by waiting 60 seconds before clamping the umbilical cord after birth instead of clamping it immediately reports the results of a systematic review and meta-analysis led by the University of Sydney's National Health and Medical Research Council Clinical Trials Centre.

The review will be published in forthcoming issue of American Journal of Obstetrics and Gynecology.

The researchers  looked into data from 18 randomized controlled trials that compared delayed vs early clamping amounting to total of 2834 infants born before 37 weeks' gestation. The cord was clamped after 60 seconds in infants allocated to delayed cord clamping group.

Infants who had their cord clamped after 1 minute faced a 32% reduced risk of mortality and 33 infants need to have delayed cord clamping to save one infant (number need to treat = 33).

Out of 18 trials, 3 trials consisted of about 1000 infants born before ≤28 weeks’ gestation. They had a 30% reduction in mortality and the number need to treat was 20.

The two groups were comparable for Apgar scores, intubation for resuscitation, admission temperature, mechanical ventilation, intraventricular hemorrhage, brain injury, chronic lung disease, patent ductus arteriosus, necrotizing enterocolitis, late-onset sepsis, or retinopathy of prematurity.

combatbootmama.com
Delay in cord clamping improved the hematocrit by 3% and 10% fewer babies required blood transfusion.

The side effects of delayed clamping were polycythemia and hyperbilirubinemia.

"The review shows for the first time that simply clamping the cord 60 seconds after birth improves survival," said the University of Sydney's Professor William Tarnow-Mordi, senior author.
"It confirms international guidelines recommending delayed clamping in all preterm babies who do not need immediate resuscitation."

"We estimate that for every thousand very preterm babies born more than ten weeks early, delayed clamping will save up to 100 additional lives compared with immediate clamping," said the University of Sydney's Associate Professor David Osborn, the review's lead author and a neonatal specialist at Royal Prince Alfred Hospital.

"This means that, worldwide, using delayed clamping instead of immediate clamping can be expected to save between 11,000 and 100,000 additional lives every year."

The study findings are in accordance with a second Australian study published in The New England Journal of Medicine. The Australian study enrolled about 1500 babies, from25 centers in 7 countries. The babies were born on an average 10 weeks early. Delayed cord clamping saved 3% more babies, as compared to immediate cord clamping (mortality was  6% vs 9%)(p=0.03).

Currently, WHO recommends waiting at least 60 seconds before cord clamping in premature and term babies.

ACOG also recommends, “a delay in umbilical cord clamping for all healthy infants for at least 30-60 seconds after birth given the numerous benefits to most newborns.” 




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