Delayed Cord Clamping vs. Immediate Cord Clamping in Term Neonates: Impact on Hematological Parameters at 48 Hours

Abstract

Introduction: Timing of umbilical cord clamping at birth influences neonatal blood volume and iron stores. Delayed cord clamping (DCC) is recommended for preterm infants, but benefits in healthy term neonates remain debated. This review evaluates the effect of DCC (≥60 seconds) versus immediate cord clamping (ICC, ≤20 seconds) on hematological parameters at 48 hours of life.

Methods: PubMed, Embase, and Web of Science were searched for RCTs comparing DCC to ICC in term neonates (≥37 weeks) without congenital anomalies. Primary outcome: hemoglobin (Hb) concentration at 48 hours. Secondary outcomes: hematocrit, bilirubin, polycythemia risk. Quality assessment used GRADE. Data pooled via inverse variance random-effects meta-analysis.

Results: Eight RCTs (n=2,134 infants) met inclusion. At 48 hours, DCC infants had significantly higher Hb (mean difference +1.25 g/dL, 95% CI 0.92–1.58, p<0.001) and hematocrit (+3.8%, 95% CI 2.7–4.9). Serum bilirubin was modestly elevated in DCC group (+0.6 mg/dL, 95% CI 0.3–0.9) but phototherapy requirement did not differ (RR 1.12, 95% CI 0.85–1.48). Polycythemia incidence was rare (<2%) and similar between groups.

Discussion: DCC improves early neonatal Hb without clinically significant hyperbilirubinemia or polycythemia. The magnitude of Hb increase is sufficient to reduce anemia risk in the first week. Limitations include varying DCC duration (60–180 sec) and lack of long-term iron status data.

Conclusions: Delayed cord clamping benefits term neonates by enhancing hematological parameters at 48 hours with minimal adverse effects. Practice guidelines should uniformly recommend DCC for all term deliveries after uncomplicated pregnancies.