For newborns diagnosed with hemolytic disease of the fetus and newborn (HDFN), a delayed clamping of the umbilical cord during delivery appears to be beneficial and safe, according to a recently published study in the American College of Obstetrics and Gynecology.
After a birth, the attending physician will clamp the umbilical cord. This procedure is usually done in the first minute after birth. However, research suggests that delaying cord clamping a few seconds after the first minute could have beneficial effects, such as a decreased need for blood transfusion and higher motor and social skills by age four.
Despite the proven beneficial effects of delayed cord clamping (DCC), there is concern regarding an increased risk of increased bilirubin levels (hyperbilirubinemia) in the newborn. Bilirubin is a metabolite product of the synthesis of hemoglobin in red blood cells; its excessive accumulation in the blood can cause yellowish coloration of the skin (jaundice) and neurological disturbances.
Read more about HDFN treatment and care
Due to this concern, the effects of DCC have not been tested in pregnancies at risk of HDFN, in which the risk of hyperbilirubinemia due to red blood cell destruction is high. The authors of this study hypothesized that DCC could have similar benefits in babies with HDFN or those at risk of HDFN.
“Our hypothesis was that the additional blood volume associated with DCC acts as an initial transfusion, allowing a higher rate of hemoglobin at birth, thus delaying [the] first transfusion after birth,” the authors wrote.
The studies used data from HDFN pregnancies in France between 2003 and 2017 in which newborns were exposed to DCC. The authors analyzed parameters such as the presence of hemoglobin at birth, the need for transfusion after birth, and bilirubin levels.
Results revealed that newborns had better hemoglobin levels in pregnancies exposed to DCC. There was no significant difference between the need for transfusions or bilirubin levels in comparison to patients not exposed to DCC.
In light of the results, the authors would recommend DCC in pregnancies with diagnosed HDFN or at risk of HDFN, given that optimal monitoring is present.
“Our results indicate a benefit of delayed cord clamping in alloimmunization, regardless of pathology severity, without increased risk of jaundice,” the authors wrote.
