Placental blood transfer and delayed umbilical cord clamping
With guidelines recommending delaying clamping of the cord at birth as part of routine care for infants, more studies emerged on the best way to improve the redistribution of placental blood into the baby at birth. The National Institute for Health Research for Patients' Benefit project led by Rabe in collaboration with Professor Ayers at City University, London compared the neurodevelopmental outcome at two- and three-and-a-half years in preterm babies benefiting from delayed cord clamping and cord milking, another alternative to increase placental blood transfer. In this first follow-up study looking at the outcomes of both methods to increase placental transfusion on preterm babies over their first three-and-a-half years, Heike Rabe and colleagues showed that neither method produced any long-term adverse effect on developmental outcome at their development at these early years’ checks.
Heike Rabe’s Cochrane Review on the optimal timing of the umbilical cord clamping has been instrumental in changing UK and international policy (EU, Canada and USA) on the use of delayed cord clamping in preterm births. In doing so, it has led to a shift in the understanding and acceptance on the importance and benefit of delayed cord clamping with these results filtering through to a shift in practice to realise these benefits.
Recommendations from the review have contributed to 17 national and international guidelines, including the World Health Organisation Care of the Newborn Infant and National Institute for Health and Care Excellence Preterm Labour and Birth guidelines, and the British Association of Perinatal Medicine Optimal Cord Management Toolkit. The Toolkit informs a national rollout of this practice to all maternity and neonatal units in England. Heike Rabe was part of a four-nation team of obstetricians, midwives and neonatologists, together with parent representation leading on the development of the Toolkit. Its implementation in maternity and neonatal units across NHS England will be supported throughout England by the Maternity and Neonatal Safety Improvement Programme. The research has changed health practitioners’ attitudes towards delayed cord clamping, increasing its adoption in clinical practice in the UK, the USA and many other countries.