402 - Delayed Cord Clamping at an Extended Time was not Associated With High Risk of Needing Phototherapy or Postpartum Hemorrhage

Poster Number: 402
Publication Number: 402.135

Maria Wilander, Lund University, Halmstad, Hallands Lan, Sweden; Ola Andersson, Lund University, Halmstad, Hallands Lan, Sweden; Jenny Svedenkrans, Lund University and Karolinska Institutet, Lund, Skane Lan, Sweden

Background:
Delayed cord clamping (CC) for 1-3 minutes is associated with improved outcome for term neonates, but there are some concerns about side effects. Hyperbilirubinemia and risk of phototherapy are still considered to be associated with delayed CC. There has also been concerns regarding higher risk of postpartum hemorrhage (PPH) when performing delayed CC. The optimal time of cord clamping is yet to be decided and clinical praxis differs widely around the world.

Objective: To describe time to cord clamping and any association with high risk of needing phototherapy and PPH.

Design/Methods: Retrospective, observational, single-center study, based on data from medical records and a documentation sheet used locally at the delivery unit. Singleton neonates, born vaginally at ≥ 35+0 weeks gestational age (GA) were included. Perinatal data including time to CC, transcutaneous bilirubin levels and estimated postpartum blood loss were collected. Bilirubin values were categorized into high, intermediate, and low risk of needing phototherapy according to a previously published algorithm. PPH was defined as postpartum blood loss > 500 ml. Primary outcome was the association between umbilical CC time and high-risk level of hyperbilirubinemia. Data was presented using descriptive statistics as appropriate to distribution of variables. Adjusted analyses were performed using logistic regression.
 

Results: We included 571 neonates (GA (mean (SD) 39.9 (1.3) weeks) in the analysis. CC was performed at a median (IQR) time of 6 (5-8) minutes and mean (SD) bilirubin level was 8.83 (4.50) mg/dL.
Postpartum blood loss was estimated to a median (IQR) of 400 (300-550) ml and 146 (25.7 %) cases were categorized as PPH.
Phototherapy was initiated in 17 (3.0 %) of the infants and 135 (23.9%) infants were in the high-risk zone of needing phototherapy. In a logistic regression model adjusted for gestational age and instrumental delivery, time to CC did not affect the risk of being categorized into bilirubin high-risk zone (OR (CI) = 1.00 (0.94-1.06), p = 0.97). Time to CC was not correlated to PPH (OR (CI) = 1.00 (0.94-1.06), p = 0.92).Conclusion(s): We conclude that there was no correlation between cord clamping time and high-risk level of hyperbilirubinemia or PPH in vaginally born neonates with GA ≥ 35+0 weeks. Although c
ontradicting the 2020 advice of the Committee Opinion of the American College of Obstetricians and Gynecologists, our findings indicate that delayed cord clamping for an extended time could be performed without ensuring additional monitoring for jaundice.
CVCV_MW_220104.pdf
Distribution of bilirubin risk zones within categories of time to cord clampingLight blue = bilirubin level within low-risk zone, blue = bilirubin level within intermediate-risk zone, dark blue = bilirubin level within high-risk zone.