Effect of timing of umbilical cord clamping on hemoglobin and hematocrit levels in preterm deliveries

Introduction: Immediate cord clamping (ICC), a fairly new birth practice, is a common routine practice in hospital settings throughout the world, replacing the decade long older practice of delayed cord clamping (DCC). A delay in clamping the cord facilitates a gentle physiologic transition that benefits all neonates, especially to the vulnerable ones, resulting in increased infant's hemoglobin and hematocrit levels. Objective: To determine the effect of timing of cord clamping on hemoglobin and hematocrit levels in preterm deliveries. Materials and Method: This was a hospital based prospective cohort study conducted in the department of Obstetrics and Gynecology, JNMC, Aligarh. A total number of 150 cases of preterm deliveries were included, which were randomly allocated to umbilical cord clamping done at<30 seconds i.e. Group A (50 cases), delayed cord clamping done at 60-120 seconds i.e. Group B (50 cases) and delayed cord clamping done at >180 seconds i.e. Group C (50 cases). Hemoglobin and hematocrit levels were assessed at birth, at 24 hours after birth and at discharge. Analysis was done using t- test, chi-square test and ANOVA test (Analysis Of Variance). Results: Mean hemoglobin and hematocrit levels at birth, 24 hours after birth and at discharge were significantly higher in the delayed cord clamped neonates as compared to the early clamped group. There was a significant rise in mean hemoglobin level in the delayed clamped group B (0.9±1.55 g/dl) and group C (1.82±1.68 g/dl) as compared to the early clamped group A, in which there was a reduction of 0.46 ± 1.66 g/dl, in hemoglobin levels. Statistically insignificant rise in mean hematocrit level was observed in delayed clamped group B (2.21 ± 2.97 %) and group C (1.24±3.22%), as compared to group A (1.41± 6.72%). Conclusion: Delayed cord clamping is associated with higher hematocrit and hemoglobin levels at birth, at 24 hours and at discharge in preterm deliveries. This is a low cost intervention and its implementation would be particularly relevant in under-resourced settings, where anemia is still a major challenge.