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A simple way to save premature babies

The American College of Obstetricians and Gynecologists already recommends delaying clamping by 30 to 60 seconds for full-term and premature newborns.

Premature babies are those born before 37 weeks of gestation. In premature infants, delayed clamping results in improved circulation, a reduced need for blood transfusions, and a lower incidence of serious complications, such as necrotizing enterocolitis or inflammation of the digestive tract.

The evidence on whether this practice benefits them is inconsistent, according to Anna Lene Seidler, lead author of two new review articles and a senior research fellow at the University of Sydney in Australia.

The new research also aimed to determine the optimal waiting time before tightening. The longest delays studied were three minutes after birth.

“We found that the longer we wait, the better and the more we can reduce mortality,” Dr. Seidler said. “We were surprised to see how consistent the results were. »

Two new papers, published in The Lancet, analyzed dozens of studies involving thousands of babies born in hospitals in various countries, including Britain, India, Iran and the United States.

One of the reviews compared the effectiveness of three techniques: immediate cord clamping, delayed clamping, and milking an intact umbilical cord so that more blood flows to the newborn.

The paper reviewed 48 randomized trials and analyzed data from 6,367 infants, finding that delayed cord clamping reduced in-hospital deaths of premature newborns by a third, compared with immediate cord clamping. There were no statistically significant differences between the other interventions.

A second review and meta-analysis, including data from 47 trials involving 6,094 participants, compared umbilical cord milking with immediate clamping less than 45 seconds after birth, between 45 seconds and up to 120 seconds after birth. birth, and two minutes or more after birth. .

The analysis revealed that the longest delay in clamping increased survival the most, compared to immediate clamping. But the authors noted that if the newborn requires immediate resuscitation, the cord should only be kept intact as long as resuscitation can be performed at the same time.

Worldwide, some 13 million premature babies are born each year, and almost a million of them die within a month of birth. An inexpensive, low-tech intervention, such as delayed cord clamping, has the potential to save many lives.

Premature births are a huge problem in the United States, where one in ten infants are born prematurely. Rates are higher among black and Native American babies than among white and Hispanic babies.

Premature birth is a leading cause of death among American infants. Infant mortality rates increased last year for the first time in decades, according to the National Center for Health Statistics. Deaths are more common among black babies.

But implementing a change in guidelines to delay umbilical cord clamping by two minutes or more can be complicated. In the United States, many premature babies are born by cesarean section and require resuscitation.

A delay could mean that necessary equipment must be brought into the operating room even if it must be kept in a sterile environment, such as a neonatal intensive care unit, said Dr. Anup Katheria, director of neonatal research. at Sharp Mary Birch Women and Newborn Hospital in San Diego.

“I don’t think we know all the ramifications that a change in the guidelines could bring,” Dr. Katheria said. “But if it really reduces the risk of death, why cut the cord?”

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