Effect of timing of delayed cord clamping on hyperbilirubinemia: A prospective quasi-experimental study

Introduction: Delayed cord clamping (DCC) results in increased hematocrit level, elevated iron stores and reduced incidence of iron deficiency anemia. However, implementation is poor because of potential complications like polycythemia and hyperbilirubinemia, resulting in an increased need for phototherapy. This study was conducted to examine the effects of different timing of delayed cord clamping on serum hematocrit levels and hyperbilirubinemia. Methods: This was a hospital-based prospective quasi-experimental study conducted at the provincial-level hospital, Bagmati Province, Nepal. A total of 114 neonates with gestational age ≥35 weeks were sequentially assigned without randomization to three parallel groups at a 1:1:1 ratio into: DCC at one minute, DCC at two minutes, and DCC at three minutes. The consecutive sampling technique was used to enroll newborns during the study period. Serum hematocrit and bilirubin level were measured at 96 hours of life. Results: Out of 125 neonates assessed for eligibility, 11 were excluded, and 114 neonates were enrolled in the study. Total serum bilirubin (TSB) in the DCC group at 1 min, 2 min, and 3 min are 14.05±3.82mg/dl, 14.89±5.51mg/dl and 15.31±4.63mg/dl respectively (F=0.70, p=0.49). A total of 28 babies required phototherapy. More babies from DCC 2 min and 3 min (10 each) required phototherapy compared to DCC at 1 min (8 babies); however, the difference wasn’t statistically significant (χ²=1, p=0.5). Conclusion: Delayed cord clamping up to three minutes did not significantly increase the need for phototherapy. Hence, it can be practiced even in resource-limited settings with no phototherapy facility