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Evidence Based Practice Research for Delayed Cord Clamping

As a senior project for my Bachelor of Science in Nursing, one of the required classes

was to do an evidence-based practice (EBP) research project. I would like to tell you a little

about our project, what we found, and the final outcome.

Delayed cord clamping (DCC) is when the medical professional delays clamping of the

newborn's umbilical cord for thirty seconds or longer. When a fetus is in the womb, the placenta

delivers oxygen to the baby from the mother's blood; after the baby is born, if the cord is not

clamped for a small period of time the blood from the placenta transfers into the newborn

providing additional benefits to the baby (Anup et al., 2015).

At the time of our research, DCC was a newer idea with a limited amount of information.

Historically standard practice was for physicians was to clamp the umbilical cord right after

birth, usually in less than thirty seconds.

Following the five steps of EBP research, our goal was to find systematic reviews,

critically appraised topics, and critically appraised individual articles because, in the hierarchy of

evidence, these are the best filtered and unbiased best practice research. Eventually, we did end

up looking at random controlled trials, cohort studies, and case-controlled studies, which are

unfiltered research but had functional case studies and analysis to help support the filtered EBP

research studies.

Topics we addressed were how long is the right time to delay cord clamping; what the

benefits were for newborn babies with DCC; if milking the cord verse delayed cord clamping

was more beneficial; and the potential side effects of delayed cord clamping.
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The results showed there are benefits for newborns who experience delayed cord from

thirty seconds to one hundred and twenty seconds in premature infants < 35 weeks' gestation

(Rabe et al., 2004). Research showed that early neonates who experienced DDC had fewer blood

transfusions due to anemia, and fewer issues of intraventricular hemorrhaging than neonates

clamped early (Brocato et al., 2016). The only risk we found of DCC was increased bilirubin,

which caused newborns to become jaundice (Nakagawa et al., 2015). However, with

phototherapy treatment, jaundice usually resolves in newborns.

Lastly, we address umbilical cord milking (UCM) versus DCC. One study indicated there

was a higher systemic blood flow to infants born cesarean and less than thirty-two weeks (Anup

et al., 2015). UCM, at the time, had a few randomized studies done, but no higher data analysis.

UCM needed to be further reviewed by better research analyses such as systematic reviews,

critically appraised topics, and critically appraised individual articles. Additionally, UCM was

another topic that deviated from our original research question, and we wanted to stay on topic.

Therefore, we suggested further review be done with UCM.

At the end of our semester, we were to present our papers to the local hospital's research

teams. We did not submit our presentation that year; I don't remember exactly the reason why the

presentations were not submitted. However, I did find out DCC was going to become standard

practice at St. Luke's because their research team had also analyzed DCC determining it was

beneficial for newborns.

After weeks of researching the subject, I became very well versed in the benefits of DCC.

As a future family nurse practitioner, I will encourage DCC to a patient who is pregnant or

thinking of becoming pregnant by educating them about the benefits of DCC. Furthermore, I will

provide brochures along with EBP paperwork showing the value of DCC. I will also discuss the
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risk of jaundice, the cause of it, why we treat it, and how phototherapy works to treat the disease.

I feel educating patients about DCC offers a newborn a little better of a chance to have a great

start in life.
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References

Anup, K. C., Truong, G., Cousins, L., Oshiro, B., & Finer, N. N. (2015). Umbilical Cord Milking

Versus Delayed Cord Clamping in Preterm Infants. Pediatrics, 136(1), 61–69.

https://doi.org/org/10.1542/peds.2015-0368

Brocato, B., Holliday, N., Whitehurst, R. M., Lewis, D., & Varner, S. (2016). Delayed cord

clamping in preterm neonates. Obstetrical & Gynecological Survey, 71(1), 39–42.

https://doi.org/10.1097/OGX.0000000000000263

Nakagawa, M., Ishida, Y., Nagaoki, Y., Ohta, H., Shimabukuro, R., Hirata, M., Yamanaka, M.,

& Kusakawa, I. (2015). Correlation between umbilical cord hemoglobin and rate of

jaundice requiring phototherapy in healthy newborns. Pediatrics International, 57(4),

626–628. https://doi.org/10.1111/ped.12583

Rabe, H., Reynolds, G. J., & Diaz-Rosello, J. L. (2004). Early versus delayed umbilical cord

clamping in preterm infants. Cochrane Systematic Review.

https://doi.org/10.1002/14651858.CD003248.pub2