延遲斷臍對新生兒黃疸與產時出血的影響－－臨床隨機實驗

The Impact of Late Umbilical Cord Clamping on Neonatal Jaundice and Postpartum Hemorrhage: A Randomized Controlled Trail

背景：雖然國外實證研究支持延遲斷臍可以增加胎盤血流灌注至嬰兒，因而可以減少嬰兒時期的鐵質缺乏，也能透過幹細胞的補充幫助嬰兒各系統的發展；但國內臨床上多數醫療院所因為擔心增加高膽紅素血症及產時出血量而採立即性斷臍。目的：探討斷臍時間對於嬰兒黃疸及產時出血的影響。方法　研究對象為北部某區域教學醫院所生產的孕婦及新生兒，採實驗性研究，隨機分派105對母嬰至實驗組（n = 44）及控制組（n = 61）。實驗組採延遲斷臍，嬰兒娩出後3分鐘斷臍，控制組採立即斷臍，斷臍時間控制在嬰兒娩出後1分鐘內，藉以比較嬰兒黃疸及產時出血的相關性。採用結構式問卷及生理計量測量方式進行資料收集，包括母嬰人口學及產科學資料、產時出血量、新生兒出生前三天之體重變化及經皮膽紅素值、出生後七天是否因黃疸而住院照光治療。結果　兩組出生三天的嬰兒其經皮膽紅素值皆隨著出生天數而上升，但兩組的經皮膽紅素值、住院期間及產後四至七天的照光治療率、住院期間照光治療時數皆無統計上之差異；延遲斷臍與產時出血量沒有相關性。結論／實務應用　本研究結果證實延遲斷臍不會增加產時的出血及產後三天的黃疸值。建議醫護人員採用延遲斷臍，並於生產教育教導個案延遲斷臍的好處，及澄清延遲斷臍對母嬰健康影響之相關疑慮。

Background: The current evidence supports the clinical benefits of late umbilical cord clamping. These benefits include increased blood volume and total body iron. Furthermore, delayed cord clamping facilitates the transplantation of stem cells, which helps the development of infant bodily systems. However, due to concerns related to postpartum hemorrhaging and neonate jaundice, most maternity units still clamp the cord immediately after a child is born. Purpose: This study investigates the impact of delaying cord clamping on neonatal jaundice and postpartum hemorrhage. Methods: A randomized, controlled trial was conducted at a regional teaching hospital in northern Taiwan. One hundred and five healthy nulliparous women at 36 weeks of pregnancy were included and allocated randomly to the experiment group (n = 44) and the control group (n = 61). Participants in the experiment group received delayed cord clamping (DCC) at 3 minutes after delivery. Participants in the control group received early cord clamping (ECC) at around 1 minute after delivery. Clinical measures of the outcomes were measured by the infant transcutaneous bilirubin levels (TcB) and postpartum hemorrhage at birth. A structured questionnaire and biophysical measures were used to collect data on participant demographics, obstetrical information, maternal blood loss at birth, neonate weight and TcB level at hospitalization, and whether or not the infant received phototherapy at 4-7 days postpartum. Results: Overall, there was no significant difference between the two groups in terms of neonatal jaundice, maternal hemorrhage at birth, and phototherapy rates at time of hospitalization and at 4-7 days postpartum. Conclusion / Implications for Practice: The findings of the present study support that late umbilical cord clamping does not increase the risk of maternal postpartum hemorrhaging or neonate jaundice. Thus, we suggest that clinicians inform clients during prenatal classes of the benefits of delayed cord clamping and also use current, evidence-based knowledge to dispel client worries regarding the dangers to maternal-neonate health of delayed cord clamping.