News Archive

By Lindy Brophy

A wait of just 60 seconds before clamping a newborn baby's umbilical cord could be the most important minute of that baby's life.

Clinical trials at King Edward Memorial Hospital and six other maternity hospitals around Australia are testing a well-researched theory that allowing another minute for blood to flow from the mother to the baby via the placenta after birth could prevent or reduce the risk of preterm babies developing infections, diseases and disabilities.

Babies born less than 30 weeks into a normal 40-week pregnancy have up to 100 times higher rates of death and illness and 10 times the rate of disabilities.

Winthrop Professor John Newnham, specialist in maternal fetal medicine in the School of Women's and Infants' Health, is one of many researchers involved in the Australian Placental Transfusion Study (APTS) which originated with British midwives delaying clamping the cord after homebirths, because they felt the rush to clamp it was unnatural.

"We have always clamped the cord immediately a baby is born, so that we can give the baby oxygen if needed and keep it warm," Professor Newnham said. "But those midwives may be right: it's not done in nature. An animal giving birth waits until the cord stops pulsating before severing it."

About 1,600 very preterm babies are part of the nation-wide trial. They represent just 1.5 per cent of all births but they account for a disproportionately high burden of mortality and conditions including brain injury, retinopathy, chronic lung inflammation, infections, poor nutrition and growth.

"Preventing these conditions is a global priority, given the associated penalties of mortality, permanent physical and intellectual impairment and long-term socio-economic cost," Professor Newnham said. "Placental transfusion, which takes place in that extra minute before we clamp the cord, is a simple, low-cost intervention that may protect very preterm babies against these morbidities."

Members of the APTS group conducted a smaller clinical trial in 2004 involving 297 babies of less than 37 weeks gestation. Evidence from that trial suggested that placental transfusion in babies at that stage of development was safe, well-tolerated and reduced the risk of brain haemorrhage and necrotising enterocolitis (death of part of the bowel wall) by 40 per cent or more. These are common in preterm babies.

Professor Newnham said if the complications associated with a very preterm birth were reduced, it could also lead to fewer cases of cerebral palsy, another condition found among babies born too early.

"This is potentially the most exciting development in the way we care for mothers and babies in preterm labour and birth," he said. "And it is such a simple thing."

Blood from the placenta of a preterm baby is rich in stem cells that provide immunity against infection. They might also protect against inflammation and protect the nervous system.

The APTS trial is being run out of the University of Sydney with Professor Newnham as the senior obstetrician. Two UWA neonatologists, Winthrop Professor Karen Simmer and Associate Professor Andy Gill, are involved in the care of the babies after birth.

The grant of $2.7 million for the trail is the biggest NHMRC grant ever awarded in perinatal medicine.

The benefits of waiting even just 60 seconds to clamp the cord are presumed to be the increased flow of placental blood to the newborn baby.

"But maybe it could also be that the 60 seconds of just leaving a baby alone, instead of immediate intervention, even if it is only to cut the cord and swaddle the baby, could be important," Professor Newnham said.

Published in UWA News , 6 August 2012