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Delayed Cord Clamping And Jaundice – What You Need To Know
We now know that delayed cord clamping has a whole host of benefits – both immediate and long-term.
When we make birth decisions, we want to be sure we're making the best choices. Often that means weighing up the benefits and risks of each option.
In recent decades, immediate umbilical cord clamping was the norm. Recently there's been a shift towards routinely delaying cord clamping.
As a newer practice becomes more common, people start to look for connections with possible benefits or risks.
Some medical professionals had voiced their concern about an increased risk of neonatal jaundice (hyperbilirubinemia) among babies who had delayed cord clamping. In fact, this concern was sometimes used as a reason to deter patients from choosing delayed cord clamping, despite the many proven benefits.
Does Delayed Cord Clamping Increase The Risk Of Jaundice?The World Health Organization (WHO) recommends routine delayed cord clamping for all babies, unless they need immediate medical attention that can't be accessed on or near their mother.
The WHO makes its recommendations after extensive research and data review. Before making this recommendation, it reviewed data that revealed several significant benefits. One benefit was that infants who had delayed cord clamping had much better iron stores. This significantly lowered their risk of iron deficient anaemia in the first six months.
Cord blood contains around one third of a baby's volume of blood. So the baby stands to lose a significant amount of iron (and blood in general) if the cord is clamped immediately.
The WHO also found the rate of jaundice was not higher among newborns who had delayed cord clamping. However, they found an increased need for phototherapy to treat jaundice among newborns who had delayed cord clamping.
Even with the increased risk of the need for phototherapy, there's little to no evidence to suggest that the risk outweighs the many known benefits of delayed cord clamping.
What Is Jaundice?The body produces a substance called bilirubin, which breaks down old red blood cells. While baby is in utero, the placenta is responsible for removing bilirubin. After birth, baby's liver takes over the task of eliminating bilirubin from the blood.
In 60% of newborns, hyperbilirubinemia (elevated levels of bilirubin in the blood), or jaundice, occurs.
When baby has yellowing of the skin and whites of the eyes, or lethargy, then normal newborn jaundice is typically the culprit.
Is Jaundice Dangerous?In short, jaundice is a descriptive symptom and not a disease.
When we first started testing babies for jaundice, we assumed that elevated bilirubin was automatically a health risk. We now know that bilirubin is a powerful antioxidant. It probably has an important role in the transition from womb to world.
If we take a moment to look at biological norms, it wouldn't make sense for 60% of healthy babies to have jaundice if it were a serious and abnormal complication. For healthy, full-term infants born after 37.5 weeks gestation, jaundice is rarely serious, and rarely requires treatment. Usually, it just needs to be monitored.
Preterm babies, those with low birthweight for gestational age, and infants not properly transferring milk (i.E. Dehydrated) are at risk of jaundice with potential complications. Blood group incompatibility, certain diseases and infections can also be associated with jaundice. However, there is treatment available to prevent or lower the risk of complications.
How Is Jaundice Treated?It's important to remember that jaundice is simply a descriptive symptom, much like coughing. Like a cough, jaundice has different causes. The reason for the jaundice determines how it's treated.
There are three types of jaundice:
Physiological Jaundice is often called normal newborn jaundice. It occurs from around day 2-4 of life and is resolved by 1-2 weeks (or 3 weeks in premature babies). It is simply due to the transition that takes place after birth, when the immature liver must start to process the bilirubin that had been processed by the placenta before birth. There's no underlying disease or illness associated with this type of jaundice.
Babies with physiological jaundice are monitored, and might not require any treatment. If baby is lethargic, too sleepy to eat, or bilirubin levels are very elevated, phototherapy might be recommended. Additional IV fluids might be given to help the body flush bilirubin, if levels get too high.
Pathological Jaundice is jaundice caused by an underlying medical condition or concern. This possibility is always considered when baby shows signs of illness, or if jaundice levels are very high within 24 hours to 10 days of life.
Pathological jaundice might also be treated with phototherapy to help lower bilirubin levels. The underlying cause for the jaundice (infection, disease, etc) is treated at the same time.
Breast Milk Jaundice is a bit of a silly term, considering breast milk is our biological norm. Nonetheless, this term is used when an exclusively breastfed baby has jaundice that appears around 5-7 days of life, and persists for a few weeks, even a few months. This is physiologically normal, and nothing to be concerned about. Even so, the baby will probably be monitored, to make sure the higher bilirubin levels are not caused by low milk intake, or by pathological conditions.
Breast milk jaundice rarely requires treatment. It's important parents wake any sleepy babies to be sure they're transferring plenty of milk via frequent feeds. It's a good idea to work with an IBCLC lactation consultant if there are concerns about milk transfer.
If baby is overly lethargic, or less than 37.5 weeks gestation, phototherapy might be beneficial.
We used to treat breast milk jaundice with formula. Now, unless a baby is genuinely unable to get enough breast milk, we know there's no benefit in routinely supplementing jaundiced babies with formula.
Does Phototherapy Have Risks?Phototherapy is a noninvasive treatment. It can be done via admission to hospital, where baby will be placed under a bilirubin light. It can also be done via home care (in some areas) with a portable bili blanket. This method is used for cases of borderline hyperbilirubinemia (levels less than 19).
The treatment and monitoring of jaundice often requires a heel prick for blood testing. It can be unpleasant, but it carries little risk.
Does The Benefit Of Delayed Cord Clamping Outweigh The Risk Of Jaundice And Phototherapy?In short, in healthy full-term infants, delayed cord clamping has many known benefits. The benefits are very likely to outweigh the risk of jaundice, even when phototherapy is required.
This is often true for preterm and unwell infants, too. If you're at risk for a preterm birth, discuss delayed cord clamping with a neonatologist, so that you have a plan that everyone is confident about.
Delayed cord clamping decreases the risk of iron deficient anaemia for baby's first six months of life. It also has many other short and long term benefits.
You can read more about all of the benefits in BellyBelly's articles Delayed Cord Clamping – Why You Should Demand It and Delaying Cord Clamping May Offer Years Of Benefits, Study Finds.
Why Was This Patient Turning So Yellow?
By morning, the man was feeling better — the jammed gallstone must have gotten loose and moved on. He was sitting up in bed, reading his phone, when he noticed a small group of doctors collecting outside his door. A young woman gave what he recognized as a description of his own presentation to the emergency room. Then an older doctor began talking about jaundice, the yellowing of the skin and eyes. The color came from a buildup of something known as bilirubin, a breakdown product of red blood cells. Normally there is a constant low level of this dark-colored waste created and disposed of as red blood cells are born and die. But there are diseases that can increase bilirubin levels — either because something happens to block its excretion or because more red blood cells are being broken down, causing more bilirubin to be made. In this patient's case, the stuck gallstone blocked the flow of bilirubin into the gastrointestinal tract. But that doesn't usually cause jaundice like this. The whites of a patient's eyes might be a little yellow — it's where jaundice is most easily seen — but this man was visibly yellow everywhere. He had far more bilirubin than would be expected in a blocked gallbladder. Our job, he explained to the doctors in training, is to figure out why.
"Do you think I'm hemolyzing?" the patient called out from his bed. Silence fell as every face turned toward him. Hemolyzing, they knew, was the destruction of red blood cells. But this wasn't a word patients usually used. The patient got out of bed and ambled to the doorway. He could see the unasked question in their eyes. He went to medical school, he told the group, though he never went into practice.
Dr. Peter Braverman introduced himself and the three doctors in training on the team. Here's something else interesting, he told the patient and the trainees. If you look at the blood-cell count, you can see that this young man has an anemia — a lower-than-usual number of red blood cells. That's rare in a man. And the blood cells he does have are very, very small. Usually you see that only with a severe iron deficiency or with some anomaly in the shape of the red blood cells. Normal ones are shaped like SweeTarts candies — disc-shaped, with an indentation on each side. That shape allows the cells maximal flexibility in order to move through the narrowest capillaries in the body. Red blood cells with any other shape are destroyed at a much higher rate. That can give you jaundice, especially if the elimination of the extra bilirubin is blocked. Let's reach out to the hematology service, the doctor said, to help us figure out the mysteries of this man's blood.
Braverman, meanwhile, was curious. This young man had medical training. What did he make of his yellowed skin and eyes? The patient looked away uncomfortably. Actually, he hadn't noticed it. During the pandemic, he moved in with his parents and was working from home. He had been quite isolated. Hadn't been to his office. Hadn't seen his friends. His parents, who were elderly, hadn't said a word. And he didn't look in the mirror much. In past years he noticed that the whites of his eyes sometimes had a yellow tint to them. Based on that, he had diagnosed himself with Gilbert's syndrome, a benign condition that is caused by not having enough of the enzymes that break down bilirubin. People with Gilbert's may have a yellowish cast to their eyes, especially during times of physical or emotional stress, when red blood cells are broken down more rapidly. But he never connected the yellow he sometimes saw in the mirror to the bouts of abdominal pains. And he had never been this yellow.
Got Gerber Baby Formula In Your Pantry? Check For These Lots Codes If You Live In KY
A batch of Gerber baby formula was shipped to eight U.S. States — including Kentucky — even after it was recalled for possibly containing a bacteria known to cause serious infections in infants.
According to CNN, the batch was sent to a wholesale distributor in Nashville before it was shipped to grocery stores in Alabama, Georgia, Indiana, Ohio, Tennessee, Virginia, West Virginia and Kentucky.
This happened even after the initial recall notice March 17, according to a company news release shared by the U.S. Food and Drug Administration.
Here's what to know about the recall and how it could affect Kentuckians.
Which baby formula product has been recalled?Certain lots of Gerber Good Start SoothePro powdered infant formula were voluntarily recalled March 17, according to the company's news release. These batches were manufactured at the Perrigo Company's facility in Eau Claire, Wis., from Jan. 2 to Jan. 18, 2023.
The product was recalled "out of an abundance of caution" due to possibly containing cronobacter sakazakii, the release said.
How can I tell if my baby formula is safe?You bought this particular product, you should check the can for the following lot codes and use by dates, per the release:
If your formula has one of the matching codes, stop using the product and throw it away immediately.
You can request a refund by calling the Gerber Parent Resource Center at 1-800-777-7690, the company said.
What is cronobacter sakazakii and why is it harmful to infants?Cronobacter sakazakii is a bacteria naturally found in the environment, like in your yard, kitchen or living room. According to the U.S. Centers for Disease Control and Prevention, it can trigger serious infections and resulting complications.
These infections affect the bloodstream and nervous system, according to the CDC, and can include sepsis and meningitis. Complications can result in brain abscess, developmental delays, motor impairments and death.
Symptoms of the bacteria to watch out for include poor feeding, irritability, temperature changes, jaundice, grunting breaths or abnormal body movements, per the CDC.
The groups most at risk are infants younger than 2 months old, babies born premature or with low birth weights or those with weakened immune systems. However, all people with immune issues are at increased risk, regardless of age, the CDC said.
Do you have a question about product safety in Kentucky for our service journalism team? We'd like to hear from you. Fill out our Know Your Kentucky form or email ask@herald-leader.Com.
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