by Trisha Korioth • Staff Writer
Umbilical cord clamping should be
delayed in term and preterm infants
due to several health benefits, according to AAP-endorsed guidance from the American
College of Obstetricians and Gynecologists (ACOG).
Released Dec. 21, Delayed Umbilical Cord Clamping
After Birth ( http://bit.ly/2j8VkcP) is an update to a
2012 ACOG committee opinion.
The new guidance, which was published in
Obstetrics and Gynecology in January, “recommends a
delay in umbilical cord clamping in vigorous term and
preterm infants for at least 30-60 seconds after birth.”
It cites several benefits to term and preterm infants,
and the position concurs with recommendations from
The Academy previously supported the ACOG recommendation to delay clamping for preterm infants.
In 2015, the Neonatal Resuscitation Program issued
guidelines recommending delayed cord clamping for
at least 30-60 seconds for most babies born at term
or preterm ( http://bit.ly/2h3Tji1). The World Health
Organization recommends that the umbilical cord not
be clamped earlier than one minute after birth for term
and preterm infants.
“While there are various recommendations regarding
optimal timing for delayed umbilical cord clamping,
there has been increased evidence that shows that the
practice in and of itself has clear health benefits for both
preterm and term infants,” Maria A. Mascola, M.D.,
lead author of the committee opinion and ACOG li-
aison to the AAP Committee on Fetus and Newborn,
said in a news release. “And, in most cases, this does not
interfere with early care, including drying and stimu-
lating for the first breath and immediate skin-to-skin
According to the new committee opinion:
• Delayed clamping in term infants increases hemo-
globin levels at birth and improves iron stores for
several months after birth, which may favorably
affect infant development.
• For preterm infants, delayed clamping may im-
prove transitional circulation and help increase red
blood cell volume. It also reduces the need for
blood transfusions and the incidence of necrotiz-
ing enterocolitis and intraventricular hemorrhage.
• Delayed cord clamping could lead to a slight
increase in cases of jaundice that would require
phototherapy in term infants. ACOG urges the
adoption of mechanisms to monitor and treat
Delayed clamping does not put mothers at greater
risk of postpartum hemorrhage, the committee noted. However, immediate clamping is necessary in cases
of maternal hemorrhage or hemodynamic instability,
abnormal placentation or if there is a need for immediate resuscitation of the infant or if infant placental
circulation is not intact.
More research is needed on the benefits of umbilical cord milking, according to the committee opinion. This practice of rapidly transferring umbilical cord
blood to the infant is used when a delay in umbilical
cord clamping after birth is not possible.
Families considering cord blood banking will require
counseling on the benefits of transfusion at birth vs.
banking for future use, the committee wrote. Delayed
cord clamping makes it less likely that donation and
banking criteria are met.
“The ability to provide delayed umbilical cord
clamping may vary among institutions and settings,”
the committee wrote. “Decisions in those circumstances are best made by the team caring for the mother-in-fant dyad.”
While there are many known benefits to delaying
umbilical cord clamping for at least 30-60 seconds,
more research is needed on the benefits of umbilical
cord milking, according to AAP-endorsed guidance