It is always the wish of all mothers to carry their pregnancy to term and deliver healthy babies that can have a good start to life.
As a result, many women usually do whatever is possible during pregnancy to protect their newborns from any harm. These include adopting healthy diets, undergoing frequent medical check-ups and keeping off strenuous physical activities.
Nevertheless, the course that pregnancy takes is unpredictable. Therefore, for one reason or another, some women may find themselves delivering preterm or premature babies (born before 37 weeks).
This may be as a result of prior multiple pregnancies, genetics or family history, infections and chronic conditions such as diabetes and high blood pressure. But oftentimes, the cause may remain unknown.
According to the World Health Organisation (WHO), preterm births — currently on the rise — are the leading cause of death among children under five years globally.
The situation is dire in developing countries like Kenya where most of these premature babies die due to a lack of feasible, cost-effective care like warmth, breastfeeding support, basic care for infections and breathing difficulties.
Most of the affected children that survive face a lifetime of disability including learning challenges, visual problems and hearing issues.
A new study published in The Lancet Child and Adolescent Health Journal offers insights on an innovative approach that can help boost the survival chances of premature babies.
Based on the findings of the research, the delayed clamping of umbilical cords for babies born before 30 weeks (by a minute) reduces a child’s relative risk of death or major disability in early childhood by 17 percent. This includes a 30 percent reduction in mortality before the age of two.
In addition, the study also revealed that these children have a15 percent lower chance of needing blood transfusions after birth.
In Kenya, this new technique could come in handy for health practitioners, by offering a solution aimed at improving the survival chances of the more than 193,000 children born prematurely each year.
“It’s very rare to find an intervention with this sort of impact that is free and requires nothing more sophisticated than a clock.
“This could significantly contribute to the UN’s Sustainable Development goal to end preventable deaths in newborns and children under five — a goal which has really suffered during the pandemic,” said William Tarnow-Mordi, the lead author of the study and professor of Neonatal Medicine at the University of Sydney, in Australia that led the research.
He noted that the simple process of aiming to wait a minute before clamping the umbilical cord of affected babies will have a significant impact worldwide.
“Applied consistently worldwide, aiming to wait a minute before cord clamping in very preterm babies who do not require immediate resuscitation could ensure that an extra 50,000 survive without major disability in the next decade,” said biostatistician Kristy Robledo from the University of Sydney who was also part of the research team.
“In other words, for every 20 very preterm babies who get delayed instead of immediate clamping, one more will survive without major disability.”
Cord clamping
Delayed umbilical cord clamping is a common practice among full-term mature babies as it gives the newborn time to adapt to life outside the womb.
However, for a long time, clinicians have been cutting the cord of preterm babies immediately after birth so as to accord them urgent medical care.
“For years, umbilical cords were routinely clamped quickly after a very preterm birth and the baby was passed to a paediatrician in case the child needed urgent help with breathing,” said Prof Tarnow-Mordi.
“But we now know that almost all very preterm babies will start breathing by themselves in the first minute if they are given that time.”
“We think that, after delaying cord clamping, babies get extra red and white blood cells and stem cells from the placenta, helping to achieve healthy oxygen levels, control infection and repair injured tissue.”
The findings of the new research originated from a follow-up study of the award-winning Australian Placental Transfusion Study, which was the largest-ever clinical trial of delayed cord clamping of babies born before 30 weeks worldwide. It was conducted in 25 hospitals across seven countries.
“Moving forward it’s vital that perinatal professionals record the time of first breath and cord clamping to the second during births to allow for robust, large-scale data to further our work in this area,” said Jonathan Morris, a co-author of the study and professor of Obstetrics and Gynaecology at the University of Sydney.
“Intensive staff training in the new protocols will also be vital as it can be daunting to delay treatment in very early and sick babies, but the evidence suggests this results in the best outcomes for these children.”
The first evidence indicating that delayed umbilical cord clamping might have benefits for preterm infants and their mothers came in 2017 from a small-scale study and was published in the American Journal of Obstetrics and Gynaecology.
Based on these emerging studies, the WHO recommends that newborns, including preterm babies who do not require positive pressure ventilation, should not have their cord clamped earlier than one minute after birth. But this has not always been consistently applied.
Health experts note that the findings of this study, based on a large-scale trial, strengthen the evidence on this simple innovative approach and will thus encourage or hasten its adoption worldwide.
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