NALS AHA 2015

Umbilical Cord ManagementNRP 787, NRP 849

• Until recent years, a common practice has been to clamp the umbilical cord soon after birth to quickly transfer the infantto the neonatal team for stabilization. This immediate clamping was deemed particularly important for infants at high riskfor difficulty with transition and those most likely to requireresuscitation, such as infants born preterm. During the 2010 CoSTR review, evidence began to emerge suggesting thatdelayed cord clamping (DCC) might be beneficial for infantswho did not need immediate resuscitation at birth.7
• The 2015 ILCOR systematic reviewNRP 787 confirms that DCCis associated with less intraventricular hemorrhage (IVH) of anygrade, higher blood pressure and blood volume, less need fortransfusion after birth, and less necrotizing enterocolitis. There was no evidence of decreased mortality or decreased incidenceof severe IVH.1,2 The studies were judged to be very low quality(downgraded for imprecision and very high risk of bias). The onlynegative consequence appears to be a slightly increased level of bilirubin, associated with more need for phototherapy. These findingshave led to national recommendations that DCC be practicedwhen possible.9,10
•  A major problem with essentially all of these studies has been that infants who were thought to require resuscitation were either withdrawn from the randomized controlled trialsor electively were not enrolled. Therefore, there is no evidence regarding safety or utility of DCC for infants requiring resuscitationand some concern that the delay in establishing ventilation may be harmful. Some studies have suggested that cord “milking”might accomplish goals similar to DCC,11–13 but there is insufficient evidence of either its safety or utility to suggest its routineuse in the newly born, particularly in extremely preterm infants.
• NALS AHA 2015  nals 2015