Are babies who had delayed cord clamping less likely to develop neonatal hypoglycaemia?

Umbilical cord clamping should occur not earlier than 1 minute after birth if the baby’s condition allows. [Conditional recommendation]

Low certainty evidence shows that delayed cord clamping may result in small reduction in neonatal hypoglycaemia, moderate reduction in neurodevelopmental impairment at 12 to 24 months, moderate reduction in neonatal mortality, and small increase in fully breastfeeding at hospital discharge.

The New Zealand College of Midwives (2024) guidelines suggest delaying cord clamping for 3 minutes or until the umbilical cord stops pulsating (whichever occurs later) for term and pre-term babies who do not require resuscitation at birth, as this is associated with improved neonatal outcomes. WHO (2023) also recommends delayed umbilical cord clamping (not earlier than 1 minute after birth) for improving maternal and infant health and nutrition outcomes.

If the baby becomes hypothermic, this could increase the chances of hypoglycaemia. Place the baby directly on the mother’s chest immediately after birth and cover both with a warm blanket.

If the baby is unwell and needs resuscitation, cord clamping before one minute after birth might be required.

Nil.

Health equity for Māori

Health professionals must apply this guideline equitably to prevent harm and ensure accountability in implementing recommendations for Māori as part of a pro-equity approach. Pākehā benefit from health system privileges, while Māori face systemic racism, leading to reduced health benefits. Health equity can be improved if Māori receive effective interventions.

Ensure Māori whānau are fully informed about their healthcare options as a part of a mana motuhake (self-determination), including prevention, monitoring and treatment options, health benefits and potential risks. Detailed explanations of all interventions, their necessity, and results should also be provided to help achieve equitable health outcomes. Ensure whānau are provided with information in multiple formats (oral, written, online, video) that align with cultural values.

Whānau living in rural areas may face additional financial costs and barriers to accessing specialist services. Proactively support these whānau by informing and supporting them to access available financial assistance and resources to access specialist services.

Health equity for other groups

Health professionals must apply this guideline equitably to prevent harm. Health equity can be improved if all whānau receive effective interventions.
Many groups, including Pacific, Asian, migrant and rural communities, also face significant health inequities. These groups often encounter barriers such as language difficulties, lower health literacy, and challenges in understanding their healthcare options. It is important that all whānau are fully informed about their healthcare options, including prevention, monitoring and treatment options, health benefits and potential risks. Detailed explanations of all interventions, their necessity, and results should also be provided to help achieve equitable health outcomes. Culturally appropriate communication, use of interpreter services where required, along with the use of multiple formats (oral, written, online, video), can help improve engagement with health services.

Rural communities may also experience additional challenges, such as increased travel costs and limited access to specialist care. Providing proactive support, including information about and assistance to access financial and other resources to help access specialist services, is crucial to reducing these inequities and improving health outcomes. Specific additional issues are addressed under the recommendations and EtDs where relevant.