Factors associated with umbilical cord clamping in term newborns

To identify factors associated with umbilical cord clamping in term newborns and to compare the recording of clamping time in the medical record with what was observed.

METHOD:

Cross-sectional study, with 300 mothers-infants, in a university hospital. Clamping time and medical records were observed, and a structured questionnaire was applied to postpartum women for sociodemographic variables. Bivariate analysis, multivariate Poisson Regression model, and Kappa concordance test were performed.

RESULTS:

The percentage of late/optimal clamping observed was 53.7%. The associated factors were skin-to-skin contact in the delivery room (PR = 0.76; 0.61–0.95; p = 0.014), position of the newborn below the vaginal canal (PR = 2.6; CI95%: 1.66–4.07; p < 0.001), position of the newborn at the vaginal level (PR = 2.03; CI95%: 1.5–2.75; p < 0.001), and need for newborn resuscitation in the delivery room (PR = 1.42; CI95%; 1.16–1.73; p = 0.001). Kappa concordance level of the professionals, records compared to the observation was: nurse 0.47, obstetrician 0.59, and pediatrician 0.86.

CONCLUSION:

the identification of associated factors and the comparison between recording and observing the clamping time can help in the planning and implementation of improvements for adherence to good practices at birth.

DESCRIPTORS
Umbilical Cord; Obstetric Nursing; Obstetrics; Records; Infant, Newborn; Neonatology

Variables	n (%)	p
Maternal age		0.329
<20 years	45 (15)
20 to 35 years	210 (70)
≥35 years	45 (15)
Self-declared color		0.004
White	178 (59.3)
Black	67 (22.3)
Brown/Brunette/Mulatto	53 (17.7)
Yellow	2 (0.7)
Years of complete study		0.650
<8 years	65 (21.7)
≥8 years	235 (78.3)
PN visits		0.502
<8 consultations	80 (26.7)
<8 consultations	220 (73.3)
Newborn sex		0.804
Female	148 (49.3)
Male	152 (50.7)
Newborn weight		0.929
2500 to 2999	81 (27)
3000 to 3999	195 (65)
≥4000	24 (8)
Newborn classification		0.606
SGA	43 (14.3)
AGA	233 (77.7)
LGA	24 (8)

Variables	n (%)	p
Delivery		0.002
Vaginal	155 (51.7)
Vaginal with forceps	12 (4)
C-section	133 (44.3)
Clamping moment		<0.001
Defined by obstetrician	88 (29.3)
Defined by the pediatrician	212 (70.7)
Newborn position during transfusion		<0.001
Below the vaginal canal	27 (9)
Vaginal level	34 (11.3)
Abdominal/thoracic level	239 (79.7)
Newborn day and time of birth		0.036
Day of week/morning	38 (12.7)
Day of week/afternoon	69 (23)
Day of week/night	101 (33.7)
Weekend/morning	22 (7.3)
Weekend/afternoon	33 (11)
Weekend/night	37 (12.3)
1-minute Apgar		<0.001
<7	25 (8.3)
≥7	275 (91.7)
Obstetric complications at childbirth
Uterine hypotonia	25 (8.3)	0.638
Increased bleeding	30 (10)	0.479
Hypertensive peak	5 (1.6)	0.122
Newborn complications until discharge
Jaundice	35 (11.7)	0.919
Polycythemia	3 (1)	0.300
Breathing difficulty	45 (15)	0.067
Newborn resuscitation required	107 (35.7)	<0.001
Amniotic fluid appearance		0.003
Clear amniotic fluid	238 (79.3)
Meconium-stained amniotic fluid	62 (20.7)
Breastfeeding in the vaginal/surgery delivery room	94 (31.3)	<0.001
Skin-to-skin contact in a vaginal/surgery delivery room	200 (66.7)	<0.001

Variables	Early/immediate n (%)	Late/optimal n (%)	P
Delivery			0.002
Vaginal	60 (43.2)	95 (59)*
Vaginal with forceps	3 (2.2)	9 (35.4)
C-section	76 (54.7)*	57 (5.6)
Clamping moment			<0.001
Defined by obstetrician	56 (40.3)*	32 (19.9)
Defined by the pediatrician	83 (59.7)	129 (80.1)*
Newborn position during transfusion			<0.001
Below the vaginal canal	27 (19.4)*	0 (0)
Vaginal level	34 (24.5)*	0 (0)
Abdominal/thoracic level	78 (56.1)	161 (100)*
Newborn day and time of birth			0.036
Day of week/morning	18 (12.9)	20 (12.4)
Day of week/afternoon	29 (20.9)	40 (24.8)
Day of week/night	52 (37.4)	49 (30.4)
Weekend/morning	16 (11.5)*	6 (3.7)
Weekend/afternoon	11 (7.9)	22 (13.7)
Weekend/night	13 (9.4)	24 (14.9)
1-minute Apgar			<0.001
<7	22 (15.8)*	3 (1.9)
≥7	117 (84.2)	158 (98.1)*
Newborn resuscitation required	70 (50.4)*	37 (23)	<0.001
Amniotic fluid appearance			0.003
Clear amniotic fluid	100 (71.9)	138 (85.7)*
Meconium-stained amniotic fluid	39 (28.1)*	23 (14.3)
Breastfeeding in a vaginal delivery room/surgery	29 (20.9)	65 (40.4)*	<0.001
Skin-to-skin contact in the vaginal/surgery delivery room	76 (54.7)	124 (77)*	<0.001

Variables	Multivariate PR (95%CI)	P
Newborn position during transfusion
Below the vaginal canal	2.60 (1.66 – 4.07)	<0.001
Vaginal level	2.03 (1.50 – 2.75)	<0.001
Abdominal/thoracic level	1.00
Newborn resuscitation required
Yes	1.42 (1.16 – 1.73)	0.001
No	1.00
Skin-to-skin contact in the vaginal/surgery delivery room
Yes	0.76 (0.61 – 0.95)	0.014
No	1.00

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author: Juliana Karine Rodrigues Strada Rua São Manoel, 963, Bairro Rio Branco 90620-110 – Porto Alegre, RS, Brazil julianakrstrada@gmail.com

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Factors associated with umbilical cord clamping in term newborns* * Extracted from the dissertation “Fatores associados ao clampeamento do cordão umbilical em um Hospital Universitário”, Escola de Enfermagem da Universidade Federal do Rio Grande do Sul, 2020.

Factores asociados al clampaje del cordón umbilical en recién nacidos a término

ABSTRACT

OBJECTIVE:

METHOD:

RESULTS:

CONCLUSION:

Factors associated with umbilical cord clamping in term newborns^* * Extracted from the dissertation “Fatores associados ao clampeamento do cordão umbilical em um Hospital Universitário”, Escola de Enfermagem da Universidade Federal do Rio Grande do Sul, 2020.