Timing of umbilical cord clamping and its predictors among neonates in Northeast Ethiopia: a multicenter prospective observational study

BACKGROUND: Optimal umbilical cord clamping, defined as clamping between one and three minutes after birth, is recommended by the World Health Organization to improve infant health and nutritional outcomes through placental transfusion. Despite these recommendations, early cord clamping remains prevalent in many settings, depriving neonates of up to 30% greater blood volume and increasing the risk of iron deficiency anemia., Evidence on the time to cord clamping and its predictors is limited in Ethiopia. The study aim to assess the time to umbilical cord clamping and its predictors among neonates in Northeast Ethiopia. METHODS: A facility-based prospective observational study was conducted among 264 neonates from February 1 to March 2, 2025. The study participants were selected using systematic sampling technique. Data were collected via observation and structured checklists and analyzed using STATA 17. Each neonate was observed for a fixed maximum of 60 s from birth. Cord clamping within 60 s was considered the event of interest; neonates not clamped by 60 s were right-censored at that time point. Survival analysis was performed using Kaplan‒Meier estimates, and the Cox proportional hazards regression model was used to identify independent predictors of early cord clamping. Adjusted hazard ratios with 95% confidence intervals are reported, and variables with p values < 0.05 in the multivariable analysis were considered significant predictors. RESULTS: The overall incidence rate of early cord clamping was 8.27 per 1000 person-seconds (95% CI: 6.88-9.94). A history of preeclampsia (AHR = 3.06, 95% CI: 1.81-5.19), cesarean delivery (AHR = 3.08, 95% CI: 1.90-5.01), episiotomy (AHR = 3.48, 95% CI: 2.01-6.07), the presence of a nuchal cord (AHR = 4.08, 95% CI: 2.09-7.96), the need for neonatal resuscitation (AHR = 2.98, 95% CI: 1.20-7.37), and a first-minute Apgar score < 7 (AHR = 2.22, 95% CI: 1.05-4.67) were independent predictors of a shorter time to cord clamping. The log-rank test revealed statistically significant differences in the number of clamps across all these predictors (p < 0.001). CONCLUSION AND RECOMMENDATIONS: Early cord clamping remains highly prevalent in the study area, with more than two-fifths of neonates clamped within the first minute. Therefore, strengthening adherence to the recommendations through targeted training, institutional protocol reinforcement, and quality improvement initiatives is recommended. CLINICAL TRIAL NUMBER: Not applicable.