Optimal timing of cord clamping for the prevention of iron deficiency anaemia in infants
At the time of birth, an infant is still attached to the mother via the umbilical cord, which is part of the placenta. The infant is usually separated from the placenta by clamping the umbilical cord.
Early cord clamping is generally carried out in the first 60 seconds after birth, whereas later cord clamping is carried out more than one minute after the birth or when cord pulsation has ceased.
Delaying cord clamping allows blood flow between the placenta and neonate to continue, which may improve iron status in the infant for up to six months after birth. This may be particularly relevant for infants living in low-resource settings with reduced access to iron-rich foods.
WHO recommendations
Delayed umbilical cord clamping (not earlier than 1 min after birth) is recommended for improved maternal and infant health and nutrition outcomes.
This is a summary of WHO recommendations on optimal timing of cord clamping. The full set of recommendations can be found in 'Full set of recommendations' and in the guidelines, under ‘WHO documents’ below.
WHO documents
GRC-approved guidelines
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Delayed umbilical cord clamping for improved maternal and infant health and nutrition outcomes
Publication date: 2014 -
WHO recommendations for the prevention and treatment of postpartum haemorrhage
Publication date: 2012 -
Guidelines on basic newborn resuscitation
Publication date: 2012
Evidence
Systematic reviews used to develop the guidelines
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Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes
McDonald SJ, Middleton P, Dowswell T, Morris PS.
Cochrane Database of Systematic Reviews. 2013; Issue 7. Art. No.: CD004074. -
Summary of this review
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Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes
Rabe H, Diaz-Rossello JL, Duley L, Dowswell T.
Cochrane Database of Systematic Reviews. 2012; Issue 8. Art. No.: CD003248. - Summary of this review
Related systematic reviews
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Timing of umbilical cord clamping in term and preterm deliveries and infant and maternal outcomes: a systematic review of randomized controlled trials
Mathew JL.
Indian Pediatrics. 2011; 48:123–129. -
Late umbilical cord-clamping as an intervention for reducing iron deficiency anaemia in term infants in developing and industrialised countries: a systematic review
Van Rheenen P, Brabin BJ.
Annals of Tropical Paediatrics. 2004; 24(1):3–16. -
Late vs early clamping of the umbilical cord in full-term neonates: systematic review and meta-analysis of controlled trials
Hutton EK, Hassan ES.
The Journal of the American Medical Association. 2007; 297(11):1241-1252.