60 seconds could mean life or death for premature babies

The deaths of tens of thousands of premature babies could be prevented with a simple technique that takes just 60 seconds at birth, a new study shows.

Researchers at the University of Sydney have found that delaying the clamping of a premature baby's umbilical cord by 60 seconds can dramatically increase its chances of survival.

They examined 18 trials involving about 2800 babies born before 37 weeks' gestation and found that delayed clamping slashed the relative risk of death in hospital by a third.

"We estimate that for every thousand very pre-term babies born more than 10 weeks early, delayed clamping will save up to 100 additional lives compared with immediate clamping," said Associate Professor David Osborn, lead author and a neonatal specialist at Royal Prince Alfred Hospital.

"This means that, worldwide, using delayed clamping instead of immediate clamping can be expected to save between 11,000 and 100,000 additional lives every year."

In the study to be published in the American Journal of Obstetrics and Gynecology, they said the technique increased the volume of blood transferred from placenta to the baby, improving blood pressure and hematocrit (the proportion of red blood cells in blood).

This confirmed that placental transfusion had occurred.

Previously, "early" clamping was widely used because of concerns about harms such as from delayed resuscitation, hypothermia and jaundice.

The authors, mostly from the university's National Health and Medical Research Council's (NHMRC) Clinical Trials Centre, acknowledged that delayed clamping slightly increased the incidence of jaundice and polycythemia.

The paper confirms new findings from the Australian Placental Transfusion Study (APTS), involving more than 1500 premature babies in seven countries, that delayed clamping might reduce mortality before 26 weeks.

The separate study, published this week in the New England Journal of Medicine, found a 6.4 per cent mortality rate in the delayed clamping group compared to 9 per cent mortality rate in the immediate clamping group.

Professor William Tarnow-Mordi, a neonatal expert involved in both studies, said both papers underwent "rapid track" peer review to save the lives of as many babies as possible.

"Much of the benefit may be simply from avoiding harmful, unnecessary procedures like pushing an endotracheal tube into the larynx and inflating the baby's lungs with positive pressure which can introduce infection and traumatic alveolar damage," he said.

"We think that hospitals will start to change their protocols if they haven't already done so and that professional guidelines will be updated to reflect the evidence."

Chancellor of Sydney University, Belinda Hutchinson, said the findings made her reflect on the "dramatic" and "heartbreaking" period of life when her granddaughter, Isla, was born at 28 weeks.

While clamping wasn't discussed, she said the premature birth of Isla - 1.2kg with a collapsed lung and needing eight tubes "sticking out of every corner of her body" - showed her how important it was to support and share research to improve chances of survival of all premature babies.

"The doctor was very honest and couldn't make any promises, Isla was right on the edge, but now she is a gutsy, wonderful girl," she said. "She was surrounded by the best doctors and equipment."

"The great thing is that delayed clamping can be applied immediately anywhere in the world, it doesn't need sophisticated systems, and many thousands more can live."

Professor Roger Soll of the University of Vermont College of Medicine, co-author of the APTS, said of the 15 million babies born before 37 weeks gestation each year, 1 million die.

"This procedure costs nothing and will make a difference to families worldwide," he said.

This story 60 seconds could mean life or death for premature babies first appeared on The Sydney Morning Herald.