387 - Cord Clamping in 1821 Term and Near-Term Infants: No Correlation Between Cord Clamping Time and Bilirubin Levels or Jaundice Requiring Phototherapy.

Poster Number: 387
Publication Number: 387.134

Jenny Svedenkrans, Lund University and Karolinska Institutet, Lund, Skane Lan, Sweden; Manuela Isacson, Lund University, Stockholm, Stockholms Lan, Sweden; Maria Wilander, Lund University, Halmstad, Hallands Lan, Sweden; Andreas Winkler, Barn och ungdomskliniken Hallands sjukhus Halmstad, Halmstad, Hallands Lan, Sweden; Anna Gustafsson, Kvinnokliniken, Hallands sjukhus Varberg, Varberg, Hallands Lan, Sweden; Cecilia Götherström, Karolinska Institutet, Huddinge, Stockholms Lan, Sweden; Ola Andersson, Lund University, Halmstad, Hallands Lan, Sweden

Background: Delaying cord clamping for 2-3 minutes in vigorous term infants is well known to provide better iron stores, higher hematocrit levels and improved neurodevelopment, compared with early cord clamping. However, in systematic reviews, an elevated risk of jaundice needing phototherapy is commonly declared as a possible complication.

Objective: The aim of this study was to analyze the correlation between cord clamping time and, bilirubin levels and need for phototherapy in a large group of term and near-term vaginally born infants

Design/Methods: Pooled data from four previous studies on cord clamping were used. Data on cord clamping time and phototherapy treatment were collected. Bilirubin was measured either in serum or transcutaneously in conjunction with the metabolic screen. The correlation between cord clamping time and bilirubin level was analyzed using multiple linear regression. The association of cord clamping time to phototherapy treatment was analyzed using an adjusted logistic regression model. Factors known to affect bilirubin levels and need for phototherapy were tested for association and non-significant factors were excluded in a stepwise manner.

Results: Data from 1821 infants (50.4% boys) with recorded cord clamping time and bilirubin level were analyzed. Mean (SD) gestational age and birth weight were 40.0 (1.2) weeks and 3582 (467) g respectively. Cord clamping was performed at a median (IQR) time of 313 (180-435) sec. Mean (SD) bilirubin at metabolic screen was 8.0 (3.8) mg/dL. A total of 28 (1.5%) infants were treated with phototherapy. There was no correlation between cord clamping time and bilirubin level at metabolic screen (B=0.000, p=0.989) in a linear regression model adjusted for age at bilirubin measurement, sex, gestational age (GA) and instrumental delivery (Figure 1). Median (IQR) cord clamping time was 300 (180-478) sec in infants treated with phototherapy and 316 (180-435) sec in infants not treated with phototherapy (p=0.962). Cord clamping time had no correlation to need for phototherapy, (OR 1.00, 95% CI: 0.998-1.002, p=0.851) in a logistic regression analysis adjusted for sex, GA, small for GA and instrumental delivery.  Conclusion(s): No correlation between cord clamping time and bilirubin levels or need for phototherapy was found in this large cohort of 1821 vaginally delivered infants. The results indicate that risks of need for phototherapy after delayed cord clamping has been overstated historically and the authors suggest that delayed cord clamping can be practiced without extra concerns regarding jaundice.
Figure 1. Bilirubin level in relation to cord clamping time.No correlation was found between cord clamping time and bilirubin level at metabolic screen. Nf1821, B=0.000, p=0.989.