Unweaning premature babies late - preferably after at least two minutes - is apparently the best way to prevent the deaths of tiny babies. This is reported by The Lancet, one of the most renowned medical journals in the world, about a current Study for weaning premature babies.
Unweaning of mature children
In Germany, newborn babies born at term are usually delivered late. This is because word has long since got around in maternity clinics and among midwives that babies benefit from this. According to the German Midwives' Journal (DHZ), mature newborns who are delivered late benefit from better blood flow to the vital organs, better cardiorespiratory stability in the first ten minutes and faster establishment of breathing. In addition, there are higher haemoglobin levels in the first 48 hours of life, a higher ferritin level and less frequent anaemia in the first six to eight months. In mature, late weaned children, better fine motor skills and more pronounced social skills can also be observed later (at the age of four), together with a better myelin content in the brain.
In the S3 guideline "Vaginal birth at term" of the German Society of Gynaecology and Obstetrics and the German Society of Midwifery Science, "early cord cutting" is described as cutting between 5 seconds and 1 minute after the birth of the full-term baby. Delayed weaning" is defined as weaning between 1 and 5 minutes after birth or after the umbilical cord has pulsed out.
Depending on which management of the postnatal phase the mother chooses,
- is the recommendation A (active management of the postnatal phase): The umbilical cord should not be clamped earlier than 1 minute after the birth of the newborn, unless there is reason to believe that the umbilical cord has been injured or the newborn has a heart rate of less than 60 beats/minute with no upward trend.
- is the recommendation B (wait-and-see management of the postnatal phase): The umbilical cord should be clamped and cut within 5 minutes of the birth of the newborn.
If the woman decides that the umbilical cord should be disconnected more than 5 minutes after the birth, this wish should be respected and the woman should be supported in her decision.
Unweaning premature babies
In contrast to mature newborns, obstetric teams have to deal with Premature babies often don't have the nerve for a late weaning, because the baby usually needs to get into the medical hands of the neonatology department quickly - especially if it is not doing so well. This behaviour is not surprising given that the critical threshold for a premature baby to survive without impairment is, according to current knowledge, 25 weeks of pregnancy. If a baby is born before this and survives, the probability of oxygen deprivation and haemorrhaging is very high. And yet examples repeatedly show that even extremely premature babies can develop well.
- One Extremely premature birth is present before the 28th week of pregnancy. A birth weight of less than 1,000 grams is then not uncommon.
- From a early premature birth is when the child is born between the 28th and 32nd week of pregnancy. These children usually weigh less than 1,500 grams.
- As late or moderately premature birth are births after the 32nd and before the 37th week of pregnancy. These babies are usually born weighing less than 2,500 grams.
In Germany, around 64,500 children are born prematurely every year. That is about every 10th child. Most premature babies are born between the 32nd and 37th week of pregnancy. When the premature baby weighs between 1,000 and 1,500 grams at birth, its probability of survival is already at 91 per cent.
The only question is: Does rapid weaning really always benefit premature babies? This is exactly what the study mentioned at the beginning (report in The Lancet) were analysed. Under the direction of Australian and British scientists, 2,369 data sets were examined, which were analysed from 48 randomised studies and the individual participation data of 6,367 newborns. Different times of delayed cord cutting, cord stripping and immediate cord cutting in premature babies were then compared with each other.
And in fact, later weaning has also proven to be the most successful for premature babies! According to the study, a full third fewer children died among them by the time they were discharged from hospital compared to those who had an early umbilical cord! Cutting the umbilical cord, on the other hand, did not result in a clear difference in the death rate for both the premature babies who were cut immediately and those who were cut later.
However, these findings are not entirely new. As early as 2018, a Meta-analysis showed that later weaning can reduce the mortality rate of premature babies. One year later, in 2019, a Review The research shows that later weaning improves blood circulation (haematocrit, blood volume, red blood cells) in premature babies.
But back to the current study: it contains the recommendation that the obstetrics team should wait at least two minutes before unbabying a premature baby so that the child has as gentle and medically optimal a start to life as possible. This is because no disadvantages of this later weaning were identified.
