Can Delayed Cord Clamping Cause Jaundice?
The secret’s out – the benefits of delayed cord clamping (DCC) are well known. This simple yet significant moment of pause after a baby takes their first breath is becoming the norm, rather than a fad in maternity care. But have you heard it can increase the risk of jaundice in babies?
If you’ve been told this, well, it’s true… kind of. But before you throw away the plan to give your baby DCC, let’s unpick this theoretical barrier.
What you need to know first here is that there are two types of jaundice (yellowing of the skin/eyes). Physiological (normal) and Pathological (bad).
Physiological jaundice is normal. We commonly see it in babies around 2-3 days old. Normal jaundice is asymptomatic – that means, a well, alert baby, who is hydrated (enough wet nappies as expected for the first days), who is non-jittery, normal temperature and feeding well and not lethargic. Usually, normal jaundice remains around the face, chest and upper arms.
Pathological jaundice is symptomatic – that is lethargic, jittery, not maintaining temperature 36.5 or more, too lethargic to feed, or otherwise unwell. If jaundice is very extensive (down to hands/feet or in whites of the eyes) but baby is asymptomatic, this should still be investigated.
Pathological jaundice requires phototherapy and management in hospital, while physiological jaundice may not, and is often overcome with natural sunlight and frequent feeding/hydration with breastmilk or an artificial formula if not breastfeeding. Newborn babies should not be given water.
** Your Midwife or other health care provider is the best person to determine whether a baby is symptomatic or not, how far spread the jaundice is, and whether babe has normal or pathological jaundice.
So what is normal jaundice & why does it occur?
Your baby’s circulatory system kicks in, independent of the placenta, at birth… but the liver takes longer. This means your baby’s red blood cells are going to the liver for processing for a few days before the liver kicks in, and therefore it creates a ‘traffic jam’ of red blood cells.
When red blood cells are processed by the liver, bilirubin is formed. A high level of bilirubin creates yellowing of the skin (jaundice)…. and because there was this naturally occurring ‘traffic jam’, there will be a high level of bilirubin at once.
To put it simply ~ baby is 2-3 days old, liver kicks in, the traffic jam of red blood cells are finally processed, lots of bilirubin is made at once, this causes yellowing of baby.
How does this relate to Delayed Cord Clamping?
Simply put… delayed cord clamping allows your baby to receive more of their red blood cells than if the cord was to be immediately clamped and cut, with their blood still sitting in it. That means – more red blood cells need to be processed by the liver if cord clamping has been delayed.
Should I avoid DCC in case of jaundice?
Babies who have had DCC are also often beautifully pink in the first week rather than pale. Considering the reasons discussed above as to why normal jaundice occurs, it only makes sense that if a baby has DCC… therefore having all of their red blood cells… there could be an increased likelihood of having physiological jaundice. But that doesn’t mean you should avoid delaying cord clamping…
Some studies report DCC has been found to be linked with a slightly higher incidence of phototherapy use, however, this has not outweighed the benefits of DCC, and it should be considered whether phototherapy was the appropriate management if babe was asymptomatic.
Also of note, the statistics show that there is only a 4.36% risk jaundice in babies who have had DCC, whilst the risk in babies who have had immediate cord clamping is 2.74%, with NO increased risk of severe jaundice.
Bottom line, Delayed cord clamping has been shown to increase the risk of jaundice, compared to immediate cord clamping, by only 1.62%.