Comparison of early umbilical cord clamping v/s delayed cord clamping v/s cord milking on neonatal hemoglobin status - A randomized control study

Background & Objectives: Anemia is common among children in developing countries. In the National Family Health Survey III of India, 70% of children were anemic. In India 81% of infants between 6 and 9 months of age become anemic most due to iron deficiency. In term infants, a brief delay in clamping the umbilical cord after birth results in higher concentrations of hemoglobin (HB) and hematocrit during the neonatal period, increased serum ferritin levels and a lower incidence of iron-deficiency anemia at 4-6 months of age. This study is conducted to compare the effect of delayed cord clamping or umbilical cord milking to early cord clamping on neonatal hematological status at 48 hours of age in term neonates born in GEMS and Hospital, Ragolu, Srikakulam.Materials and methods: The study was conducted in the labor room, obstetrics operation theatre and post natal ward of GEMS and Hospital, Ragolu, Srikakulam during November 2019 to May 2021. The newborn babies were divided into 3 groups of each 55.Group 1: Early cord clamping at 30 sec after birthGroup 2: Delayed cord clamping at 60 sec after birth.Group 3: Cord milking in 10-15 sec after birth.- In our hospital cord clamping is done as early as possible, within 30 sec.- In this study delayed cord clamping was done at 60 sec after birth because maximum placental transfusion, up to 50-75%, occurs by 1min after birth.- Cord milking was done by milking of the unclamped cord towards the umbilicus 4 times in 10-15 seconds followed by clamping and cutting of the cord.All the newborn babies received the same care. At 48hours of age the hemoglobin levels were tested.Results: Total of 165 term babies were included in the study, divided into three groups (early cord clamping, delayed cord clamping and cord milking).There were 55 babies in each group. The mean haemoglobin at 48 hours of life was 17.192±1.86 g/dl in the early cord clamping group, 19.623±1.45 g/dl in the delayed cord clamping group and 19.635±1.45 g/dl in the cord milking group. Milking the umbilical cord four times before clamping and cutting the cord or Delayed clamping of the cord by 60 seconds after delivery showed higher mean haemoglobin levels at 48 hours of life compared to early clamping.Conclusions: We conclude that both delayed cord clamping and cord milking resulted in significantly higher neonatal hemoglobin at 48 hours of life as compared to early clamping with no adverse outcomes.