The director of the University of Rhode Island's Graduate Program in Nurse Midwifery, Judith Mercer, has been awarded a $392,000 federal grant to examine the effects of delaying umbilical cord clamping on premature babies.
Mercer, an associate clinical professor of nursing, will study 74 babies, born at 24 to 32 weeks, at Women and Infants Hospital for her three-year study funded by the National Institutes of Health. A typical baby is born at 40 weeks.
Mercer completed a pilot study about a year-and-a-half ago on 32 pre-term babies at Women and Infants, and said there were some positive findings. Half of the babies had routine care, meaning their umbilical cords were clamped immediately after birth, while cord clamping for the remaining babies was delayed 30 to 45 seconds.
"The babies with delayed clamping had higher blood pressure and higher glucose levels," Mercer said. "Since pre-term babies often have very low blood pressure and glucose levels, these higher levels may indicate a greater level of stability," she said. "We also found the babies with late clamping had fewer digestive problems.
"Fewer babies in the delayed group had to go home on oxygen," Mercer said. "The hypothesis is that delayed clamping allows for more circulating red blood cells. These red blood cells help to carry more oxygen to the brain and other organs, and may aid in stability and development," Mercer said, noting that such a study may also have implications for babies born at full term. "My clinical experience tells me this (delayed clamping) helps the baby but the subject needs more research to document benefit or harm."
Now, she wants to test these hypotheses on a larger group starting in April. Women will be asked if they will enroll themselves and their infants in the study when they are admitted for pre-term labor.
She'll follow the 74 infants for seven months, working with Women and Infants Doctors William Oh and Betty Vohr as neurological tests and health assessments are conducted.
In the United States, immediate clamping is routine for pre-term infants, but in England, Germany, Finland and Holland, a brief delay in clamping is more frequently practiced, Mercer said.
She quoted a recent study that found that full-term babies whose clamping has been delayed experience less anemia at three months. No research has indicated that delaying cord clamping is harmful to the baby, Mercer said. She recently published a review of all the randomized controlled trials -- the Cadillac of scientific studies -- on the subject and was unable to find any evidence of harm. Most of the studies indicated some positive findings such as higher blood pressures, less anemia, and fewer transfusions in the nursery.
"If a mom were to deliver in a snowstorm, or the back of an ambulance, it's probably better to place the infant on the mother's abdomen, cover the baby and not to clamp the cord right away," said Mercer. "The baby would be perfectly fine as nature took its course, with mom providing natural warmth and as the baby begins to live on its own."
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