Bilirubin Levels in Neonates ≥ 35 Weeks of Gestation Receiving Delayed Cord Clamping for an Extended Time - an Observational Study

OBJECTIVE: To describe bilirubin levels in neonates ≥ 35+0 gestational weeks, receiving delayed cord clamping (CC), in relation to the updated Bhutani nomogram.

STUDY DESIGN: This was a retrospective, observational study based on data from medical records and local data sheets. Singleton neonates, born vaginally at a gestational age (GA) ≥ 35+0, and with a registered time to CC and at least one registered bilirubin, were included. We excluded neonates with positive direct antiglobulin test (DAT) or hemolytic disorders. Adjusted analyses were performed using analysis of variance, and linear or logistic regression.

RESULTS: We analyzed 558 neonates, mean GA (SD) 39.9 (1.3) weeks. CC was performed at a median (interquartile range (IQR)) time of 6 (5-8) minutes. The dataset contained 1330 bilirubin measurements. Median (IQR) age at bilirubin measurement was 37 (22-54) hours. Bilirubin percentiles in neonates with CC time ≥ 2 min were similar, or lower, compared with the Bhutani nomogram between 12 and 72 hours, but with higher 95 th percentile at later hours of age. Phototherapy was initiated in 13 (2.3 %) of the neonates. We found no association between time to CC and hyperbilirubinemia (β = -0.05, p=0.07). Need for phototherapy was marginally higher in neonates with shorter time to CC.

CONCLUSION: Bilirubin levels were not correlated to time to CC. Our findings indicate that CC beyond 2 minutes can be performed without additional monitoring for jaundice.