Factors associated with timing of umbilical cord clamping in tertiary hospital of Nepal
Tóm tắt
Delayed umbilical cord clamping (DCC) (≥ 60 s) is recognized to improve iron status and neurodevelopment compared to early umbilical cord clamping. The aim of this study is to identify current umbilical cord clamping practice and factors determining the timing of clamping in a low-resource setting where prevalence of anemia in infants is high. A cross-sectional study design including 128 observations of clinical practice in a tertiary-level maternity hospital in Kathmandu, Nepal. Overall 48% of infants received DCC. The mean and median cord clamping times were 61 ± 33 and 57 (38–79) s, respectively. Univariate analysis showed that infants born during the night shift were five times more likely to receive DCC (OR 5.6, 95% CI 1.4–38.0). Additionally, infants born after an obstetric complication were 2.5 times more likely to receive DCC (OR 2.5, 95% CI 1.2–5.3), and babies requiring ventilation had a 65% lower likelihood of receiving DCC (OR 0.35, 95% CI 0.13–0.88). Despite the existence of standard protocols for cord clamping and its proven benefit, the lack of uniformity in the timing of cord clamping reveals poor translation of clinical guidelines into clinical practice. Clinical trial registration ISRCTN97846009
Tài liệu tham khảo
Lozoff B, Beard J, Connor J, Barbara F, Georgieff M, Schallert T. Long-lasting neural and behavioral effects of iron deficiency in infancy. Nutr Rev. 2006;64(5 Pt 2):S34–43 (discussion S72-91).
Radlowski EC, Johnson RW. Perinatal iron deficiency and neurocognitive development. Front Hum Neurosci. 2013;7:585.
Haas JD, Brownlie Tt. Iron deficiency and reduced work capacity: a critical review of the research to determine a causal relationship. J Nutr. 2001;131(2S-2):676S–88S (discussion 688S-690S).
Stevens GA, Finucane MM, De-Regil LM, Paciorek CJ, Flaxman SR, Branca F, Pena-Rosas JP, Bhutta ZA, Ezzati M, Nutrition Impact Model Study G. Global, regional, and national trends in haemoglobin concentration and prevalence of total and severe anaemia in children and pregnant and non-pregnant women for 1995–2011: a systematic analysis of population-representative data. Lancet Global Health. 2013;1(1):e16–25.
Ministry of Health and Population, New Era, ICF Macro, USAID. Nepal demographic and health survey. Kathmandu: New Era; 2011.
Kc A, Rana N, Malqvist M, Jarawka Ranneberg L, Subedi K, Andersson O. Effects of delayed umbilical cord clamping vs early clamping on anemia in infants at 8 and 12 months: a randomized clinical trial. JAMA Pediatr. 2017;171(3):264–70.
Bhutta ZA, Ahmed T, Black RE, Cousens S, Dewey K, Giugliani E, Haider BA, Kirkwood B, Morris SS, Sachdev HP, et al. What works? Interventions for maternal and child undernutrition and survival. Lancet. 2008;371(9610):417–40.
Mercer JS, Erickson-Owens DA. Rethinking placental transfusion and cord clamping issues. J Perinat Neonat Nurs. 2012;26(3):202–17 (quiz 218-209).
World Health Organization. Guidelines on maternal, newborn, child and adolescent health approved by the WHO guidelines review committee. Geneva: WHO; 2013.
UNICEF GoN. Multiple indicator cluster survey (MICS). Kathmandu: UNICEF; 2015.
Government of Nepal MoHP, Paropakar Maternity & Women’s Hospital. Smarika, Annual Report. Kathmandu, Nepal; 2012–13.
KC A, Målqvist M, Wrammert J, Verma S, Aryal DR, Clark R, KC NP, Vitrakoti R, Baral K, Ewald U. Implementing a simplified neonatal resuscitation protocol-helping babies breathe at birth (HBB)—at a tertiary level hospital in Nepal for an increased perinatal survival. BMC Pediatr. 2012;12:159.
Lalonde A, International Federation of G, Obstetrics. Prevention and treatment of postpartum hemorrhage in low-resource settings. Int J Gynaecol Obstet. 2012;117(2):108–18.
World Health Organization. Guidelines on basic newborn resuscitation. Geneva: WHO; 2012.
Vivio D, Fullerton JT, Forman R, Mbewe RK, Musumali M, Chewe PM. Integration of the practice of active management of the third stage of labor within training and service implementation programming in Zambia. J Midwifery Womens Health. 2010;55(5):447–54.
Hutton EK, Stoll K, Taha N. An observational study of umbilical cord clamping practices of maternity care providers in a tertiary care center. Birth. 2013;40(1):39–45.
Bimbashi A, Ndoni E, Dokle A, Duley L. Care during the third stage of labour: obstetricians views and practice in an Albanian maternity hospital. BMC Pregnancy Childbirth. 2010;10:4.
Hutchon DJ. Immediate or early cord clamping vs delayed clamping. J Obstet Gynaecol J Inst Obstet Gynaecol. 2012;32(8):724–9.
KC A, Wrammert J, Clark RB, Ewald U, Vitrakoti R, Chaudhary P, Pun A, Raaijmakers H, Målqvist M. Reducing perinatal mortality in nepal using helping babies breathe. Pediatrics. 2016;137(6):e20150117.