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Effect of delayed cord clamping on risk of hyperbilirubinemia in term newborns: A randomsed clinical trial in Nepal
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Child Health and Nutrition.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Child Health and Nutrition.ORCID iD: 0000-0002-8184-3530
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Child Health and Nutrition.ORCID iD: 0000-0002-0541-4486
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(English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227Article in journal (Other academic) Submitted
Abstract [en]

Aim: The aim of this study is to investigate the effects of delayed cord clamping on the risk of hyperbilirubinemia in term newborns.

Method: Term normal vagainal deliveries (n=540) were randomized in two groups; early (≤ 60 seconds) versus delayed (≥ 180 seconds) cord clamping between 2 October and 21 November, 2014 at Paropakar Maternity and Women's hospital in Kathmandu, Nepal. At discharge, transcutaneous bilirubin was measured on both groups. At four weeks, all parents completed a semi-structured questionnaire, health status of the baby was recorded, and jaundice was assessed and treated.

Result: Based on gestational age and age measured in hours after birth, 32.3% of the early and 33.2% of the delayed group had bilirubin levels high enough for phototherapy to be considered (p=0.78). At four weeks follow up jaundice was reported among 13 (5.1%) in the early, and 17 (6.7%) in the delayed group (p=0.57). Treatment for jaundice was gven to 3 (1.2%) of the early and 1 (0.4%) of the delayed group (p=0.62).

Conclution: Delayed cord clamping was not associated with an increased risk of hyperbilirubinaemia during the first day of the life or risk of jaundice within 4 weeks compared with early cord clamping group.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis.
Keywords [en]
Jaundice, Neonatal hyperbilirubinemia, Newborn, Umbilical cord clamping
National Category
Medical and Health Sciences Clinical Medicine
Research subject
International Health
Identifiers
URN: urn:nbn:se:uu:diva-379548OAI: oai:DiVA.org:uu-379548DiVA, id: diva2:1298726
Funder
Swedish Research Council, 2014-04229The Swedish Foundation for International Cooperation in Research and Higher Education (STINT), PT2016-6639Available from: 2019-03-25 Created: 2019-03-25 Last updated: 2019-03-28Bibliographically approved
In thesis
1. Delayed cord clamping in Nepal-Evidence for implementation
Open this publication in new window or tab >>Delayed cord clamping in Nepal-Evidence for implementation
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aims of this thesis were to investigate effects of timing of umbilical cord clamping on newborn health, and on infant outcomes up to 12 months of age in a high-risk population and to explore the context of implementing changed umbilical cord clamping practices in Nepal.

A randomised controlled trial with 540 late preterm and term infants born by normal vaginal delivery was set up at a maternity hospital in Kathmandu, Nepal. Infants were enrolled in two parallel groups (1:1 ratio), randomised to early (ECC) (≤60 seconds) or delayed cord clamping (DCC) (≥180 seconds).

To get a deeper understanding of barriers and enablers for change in clinical practise in relation to cord clamping, a qualitative study with delivery staff was set up. Focus group discussions and key informant interviews were conducted at two major delivery hospitals in Kathmandu.

Paper I showed that DCC was an effective intervention to reduces anaemia at 8 and 12 months of age in a high-risk population, which may have major positive effects on infants’ health and development.

Paper II utilised the Ages and Stages Questionnaire (ASQ) to assess neurodevelopment in infants at 12 months of age. The result showed DCC was associated with an improvement of the overall neurodevelopment at 12 months of age as compared to infants in the ECC group.

Paper III showed that DCC was not associated with an increased risk of hyperbilirubinemia during the first day of life or risk of jaundice within 4 weeks compared with the ECC group.

Paper IV demonstrated how a positive attitude towards DCC and a will to rely on research evidence when striving to do good are facilitators of change in clinical practice. However, the participants in the study were hesitant to apply DCC due to lack of national or institutional protocols and formal training. Consequently, they were forced to take informal decisions and rely on alternate sources of information.

In conclusion, delaying umbilical cord clamping for 180 seconds is safe and associated with a significantly reduced risk of anaemia at 8 and 12 months which may have neurodevelopmental effects at a later age and is not associated with an increased risk of hyperbilirubinemia during the first days of life or risk of jaundice within 4 weeks of age. In order to change cord clamping practices to comply with evidence and policies health-care staff needs to be better supported by the governance structures of the health system, with clear and approved guidelines made available and coherent training and support.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2019. p. 66
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1557
Keywords
Attitude, Clinical Practice, Ferritin, Haemoglobin, Iron deficiency, Iron deficiency anaemia, Iron status, Jaundice, Neonatal hyperbilirubinemia, Newborn, Neurodevelopment, Randomized controlled trial, Umbilical cord clamping.
National Category
Medical and Health Sciences
Research subject
Medical Science
Identifiers
urn:nbn:se:uu:diva-379616 (URN)978-91-513-0611-7 (ISBN)
Public defence
2019-05-22, Rudbeckssalen, Akademiska sjukhuset, Rudbeck entréplan, C11, Uppsala, 09:15 (English)
Opponent
Supervisors
Funder
Swedish Research Council, 2014-04229The Swedish Foundation for International Cooperation in Research and Higher Education (STINT), PT2016-6639
Available from: 2019-04-26 Created: 2019-03-25 Last updated: 2019-06-18

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Rana, NishaMålqvist, MatsKC, AshishAndersson, Ola

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