Parents who decide to store their baby’s cord blood and cord tissue are thinking ahead, wanting to do right from the start (even before the start) and taking steps to do whatever they can to protect their baby down the road. Today, many conscientious parents are also considering delayed cord clamping and many expectant parents who are interested in storing their baby’s cord blood and cord tissue are wondering if they can do both.
What is Delayed Cord Clamping (DCC)?
Delayed cord clamping (DCC) is the practice of not immediately clamping the umbilical cord after a baby is born. Instead, it involves waiting for an average of 30 to 60 seconds before clamping the cord. This practice has been in existence since the 1950s, but it gained more widespread attention in the last decade. In 2012, the American College of Obstetricians and Gynecologists (ACOG) recommended DCC specifically for pre-term babies and "vigorous-term" babies. "Vigorous-term" refers to babies who are breathing, exhibit good muscle tone, and have a heart rate above 100 beats per minute.
In January 2017, ACOG updated its delayed umbilical cord clamping recommendation to include all healthy infants, extending the delay to at least 30 to 60 seconds after birth. This change was made due to the numerous benefits that DCC offers to most newborns.
What is the History of Delayed Cord Clamping?
For delayers, it isn’t delaying; everyone else is
prematurely clamping—and history is on their side. Today, it is common for the cord to be clamped within 15–20 seconds, but up until the mid-20th century, the cord was often cut anywhere between one minute and five minutes after the birth of the child. It wasn't until after the 1950s that early clamping became more commonplace due to a number of scientific studies during the time failed to demonstrate a need to wait and more and more people were going to a hospital for delivery instead of having home births.
Does DCC impact cord blood collection?
One study from a private cord blood bank using data from 2,000 cord blood collections showed that delaying for one minute or more resulted in only a 6%–21% decrease in the total volume of cord blood collected and a 9%–31% decrease in the pre-processed total nucleated cell (i.e., white blood cell) count.
In another study from a public cord blood bank, delayed cord clamping was found to have a small effect on the number of total nucleated cells, with 60% of collections that underwent delayed cord clamping still meeting a high threshold for the number of total nucleated cells.
Current Research on DCC in Preterm Infants
The Aeriation, Breathing, Clamping 3 (ABC3)
trial is a multicenter randomized controlled clinical trial designed to investigate the impact of physiological-based cord clamping (PBCC) compared to time-based delayed cord clamping (TBCC) in very preterm infants. Current international guidelines recommend delayed umbilical cord clamping up to 1 minute in preterm infants, unless immediate resuscitation is required. However, clamping the cord before lung aeration may limit circulatory adaptation, resulting in reduced cardiac output and hypoxia. PBCC involves delaying cord clamping until lung aeration and ventilation are established, potentially leading to a more stable circulatory transition.
In the intervention group (PBCC), the umbilical cord is clamped after the infant is stabilized, defined as reaching a heart rate greater than 100 bpm and oxygen saturation (SpO2) greater than 85% while using supplemental oxygen less than 40%. In the control group (TBCC), cord clamping is time-based, occurring between 30 and 60 seconds after birth. The primary outcome measure is survival without major cerebral and/or intestinal injury. The trial aims to include preterm infants born before 30 weeks of gestation, with a target sample size of 660 infants.
The results of the ABC3 trial are expected to contribute valuable evidence for future clinical guidelines on optimal cord clamping management in very preterm infants, potentially informing practices that lead to improved clinical outcomes in this population.
Can I DCC and still save my baby's cord blood?
Yes, you can delay and save your baby’s cord blood. DCC, following the American College of Obstetricians and Gynecologists’ (ACOG) recommendation of a 30-60 second delay, may yield a slightly smaller cord blood collection, reducing the volume available for banking by approximately 10%. Therefore, if parents choose to delay clamping, it become even more crucial to select the optimal processing method that maximizes the extraction of health stem cells.
Prepacyte-CB is the Best Choice When Delayed Cord Clamping
A defining study published in the International Journal of Stem Cells examined the different processing methods for separating the stem cells from the blood). It found Cryo-Cell’s premium processing method, PrepaCyte®-CB was the most flexible method; the only processing type unaffected by volume.66
PrepaCyte-CB leads to a better separation by sedimentation of the red blood cells while keeping the white cells suspended in the plasma. This provides less crossover of the red and white cells because they aren’t sitting on top of one another. The plasma–white cell suspension is then pulled away from the red cell layer, and the white cells are then separated from the plasma. Because of the physical difference in separation, Cryo-Cell is able to capture more stem cells while reducing the red cells up to 99%. This equates to more stem cells in every collection.
How Does the Baby Benefit from DCC?
According to ACOG, delayed cord clamping can provide several benefits to a newborn baby:
- Improved transitional circulation
- Better establishment of red blood cell volume
- Decreased need for blood transfusion
- Lower incidence of brain hemorrhage and intestinal disease
- Improved iron stores for several months
- Higher systemic blood pressure between four and 24 hours of age.
- Improved myocardial function
- Improved cerebral oxygenation
- Transfer of autologous cells
However, it is noted by ACOG that there is a small risk of increased hyperbilirubinemia (jaundice) in some infants after delayed cord clamping. Hyperbilirubinemia is more commonly know as jaundice. Bilirubin is released during the breakdown of red blood cells and normally filtered out by the liver. The immature liver of a newborn may not be able to filter out the bilirubin fast enough. An estimated 50% of term and 80% of preterm infants develop jaundice. It is believed the additional red blood cells infused during DCC could increase this risk.
What Does the Research Reveal Regarding the Advantages of DCC?
In a study published in JAMA Pediatrics, 263 children were followed from birth to four years of age. Half had undergone delayed clamping and the other half had immediate cord clamping. At age four, the children who had undergone delayed cord clamping, compared with early cord clamping, were rated higher in their fine-motor and social skills, especially in boys. The study results suggest that even children born into a low-risk, high-income population may benefit in neuro-development from delayed clamping.
A study published in the Journal of Pediatrics in December 2018 of 73 infants who either underwent delayed cord clamping for an average of nearly 3 minutes or immediate cord clamping within 30 seconds found increased iron levels and myelin content (white matter) in the delayed group. The increase in myelin was found in regions associated with motor, visual and sensory functions and may lend support to the findings of the earlier study.
Are There Situations Where DCC is Not Recommended?
Yes, there are instances in which DCC may not be advantageous for the well-being of the mother, baby, or overall situation.
Sometimes there are extenuating circumstances that prevent delayed cord clamping. For example, the mother needs urgent medical attention due to hemorrhaging or the placenta isn’t in the correct position for birth. The baby may be not meet the ACOG criteria for a vigorous-term baby (breathing, exhibit good muscle tone, and have a heart rate above 100 beats per minute) or may need to be resuscitated.
If there is a family history of disorders or disease for which cord blood may be therapeutic in the future, choosing to forego delaying cord clamping may be a better choice. For example, you may be storing the cord blood for a sibling transplant. Prolonging the delay in clamping may cause the blood in the cord to clot, making it impossible to collect stem cells. If you do choose to delay and save in these instances, it should not exceed one minute.
It is important to note that DCC does not affect the collection of cord tissue, which contains a different type of stem cell and is completed after cutting the cord.
Conclusion
It's evident that parents can now have the best of both worlds – delaying clamping for up to one minute while storing valuable stem cells from cord blood – without having to sacrifice one for the other. The key to ensuring the highest quality cord blood specimen lies in selecting the best processing method: PrepaCyte-CB. With this innovative approach, you're not only safeguarding your child's future but also your family’s.
At Cryo-Cell, we've made that choice clear by being the first cord blood bank to adopt PrepaCyte-CB processing and the only private cord blood bank offering this technology to the public.