Vanessa Wellstead and baby Jack took part in the clamping trial. Picture: Robert Duncan/The West Australian

A strategy that involves counting to 60 has the potential to prevent the major complications of prematurity, including brain haemorrhage, by 40 per cent or more and is being tested at King Edward Memorial Hospital as part of a major nationwide trial.

The intervention, called delayed cord clamping, involves waiting for 60 seconds before clamping and cutting the umbilical cord instead of the standard procedure of immediate clamping within 10 seconds of delivery.

RELATED: Deliveries: a shift in time

Previous evidence suggests that the extra blood flowing to the baby from the placenta can reduce dramatically the risk of intraventricular (brain) haemorrhage, which occurs in the first 72 hours after birth, necrotising enterocolitis - death of portions of the bowel wall when the baby is exposed to feeding - and severe infection. All are very common in premature babies.

In another bid to maximise the flow of blood, the baby will be held below the placenta until the cord is cut.

John Newnham, professor of maternal fetal medicine at KEMH, said if the rate of complications was reduced, it might lead later to a reduction in cerebral palsy, also common in children born prematurely.

"This is potentially one of the major and most exciting things to happen for a while," he said. "And it is such a simple thing.

"It is adding to our list of ways in which we are improving the care of women in premature labour and the baby at birth."

Pre-term cord blood is rich in multipotent stem cells that enhance bone marrow function and immunity against infection. They may also have anti-inflammatory and neuro-protective effects.

Compared with babies born full term, very pre-term babies have up to 100 times higher rates of death and illness and 10 times higher rates of disability but a normal life expectancy.

Professor Newnham said it was presumed the benefits of delayed cord clamping flowed from the increased volume of placental blood received by the newborn baby.

Pre-term babies are low on blood and when they emerge and start breathing, the extra blood that flows to the lungs may divert blood from the brain.

However, there could be other explanations for the benefits.

"It could be that the 60 seconds of leaving the baby alone may be important," the professor said.

This meant waiting before inserting ventilator tubes into the trachea and swaddling the baby.

The multi-centre trial, known as Australian Placental Transfusion Study (APTS), attracted funding of $2.7 million from the National Health and Medical Research Council. It is the largest perinatal study grant in the council's history.

The trial will be conducted across seven centres Australia-wide, involving about 1600 very pre-term babies born under 30 weeks' gestation.

Professor Newnham said it could be argued that the real intervention was not, in fact, the delayed cord clamping but the long-established practice of clamping immediately after birth.

"Nature does not clamp the cord," he said. "Historically, in humans as in any animal, the baby drops to the ground so it is at a lower level than the uterus, the mother waits for the cord to stop pulsating and then, essentially, bites the cord.

"So with delayed clamping, we are withdrawing the intervention and that is a very challenging thing to think about. We clamp the cord mainly through tradition, I think, to get hold of the baby and warm the baby.

"Medicine has been operating on the assumption that the moment a baby comes out, you should grab hold of it, clamp the cord and cut it, immediately put the baby on to oxygen if it needs it, and warm it up.

"We are now questioning each of those procedures because they are not done in nature."

The idea of waiting before clamping came from midwives delivering term babies in homebirths in Britain.

"They thought it was unnatural to clamp the cord," Professor Newnham said.

The trial will involve all types of pre-term deliveries, including caesarean sections and twin births.

The early outcomes for the babies will be studied. It is hoped a further grant will be made available to follow up the babies at three years of age.

KEMH is expected to recruit more babies than any other centre.

It has already enrolled 20 babies into the study since December and expects to enrol up to 70 babies each year.

The West Australian

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