The Effect of Different Positions Given to the Newborn During Delayed Cord Clamping on Physiological Indicators and Comfort

Overview

During intrauterine life, the fetus is connected to the mother via the placenta; with birth, the extrauterine adaptation process begins. The first six hours after birth are defined as the "adaptation period" for the newborn and consist of three stages. In this process, the first reactive period is particularly critical because the initial assessments determine the newborn's well-being. All organs, especially the respiratory and cardiovascular systems, are rapidly activated, and adaptation parameters are monitored. Evidence-based care interventions applied by midwives during this period directly affect the newborn's physiological stability and long-term health. The timing of umbilical cord clamping is a decisive factor in this adaptation. The World Health Organization recommends waiting at least 1 minute after birth for term and stable preterm infants, ideally with a delay of 1-3 minutes for clamping. Blood flow from the placenta to the baby continues for the first few minutes after birth. Therefore, not clamping the umbilical cord until 2-3 minutes have passed or until the cord pulse has completely stopped provides a physiological blood transfer. In this process, defined as "placental transfusion," a large portion of the blood passes to the baby within the first 3 minutes, contributing to an increase in circulatory volume and hemoglobin levels. In premature infants, stem cell transfer reduces complications and provides long-term benefits. In addition, this practice increases venous return, supporting heart filling and facilitating cardiorespiratory transition. In infants who undergo delayed clamping, oxygen saturation rises faster and irregular heartbeats are less common.

Detailed description

Positioning the newborn in parallel with cord clamping also plays a critical role in oxygenation and circulatory balance. The literature has shown that the prone position increases pulmonary ventilation, raises oxygen saturation, and supports cerebral oxygenation. It is reported that it is effective in preventing problems such as apnea, bradycardia, and oxygen imbalance, especially in premature infants; and that it supports calming and motor development due to its similarity to fetal position. The importance of body position becomes even more apparent in optimizing oxygen supply in the fetal and neonatal periods due to the effect of gravity; cardiovascular and cardiopulmonary systems are sensitive to these physiological changes. In this context, appropriate body alignment increases treatment effectiveness and directly affects clinical outcomes, especially in newborns requiring respiratory support. Indeed, it is reported that the prone position, a non-invasive and easily applicable method, is effective in increasing oxygen saturation levels in newborns with respiratory distress syndrome. Positioning in the care of premature infants is central to nursing and midwifery practices and also plays a fundamental role in coordinating all other care processes. The prone position, frequently preferred in neonatal intensive care units, supports pulmonary ventilation by preventing atelectasis development, increasing gas exchange, and preventing aspiration of gastric contents into the lungs. It has also been reported that stable positions such as prone and lateral contribute to the effective removal of respiratory secretions and the increase of arterial oxygen levels; this effect has also been observed in adult intensive care patients. The research conducted aims to evaluate the effects of delivery method, cord clamping time, and delivery room practices on cerebral oxygenation. Most studies have examined term infants who experienced a smooth physiological transition. In evaluations based on cerebral oxygen saturation (CrSO2) and cerebral fractional oxygen extraction (cFTOE) values, it is seen that these parameters reach a certain equilibrium in the first 10-15 minutes of life. These findings highlight the importance of using new indicators in monitoring physiological parameters during the transition period.

Interventions

• Other Prone position
  After birth, the newborn will be positioned vertically on the linea line above the mother's mons pubis and monitored while lying prone.
• Other Left side lying position
  After birth, the newborn will be positioned vertically on the linea line above the mother's mons pubis and monitored while lying left side.

Primary outcome measures

• Heart rate (pulse) [Time frame: During delayed umbilical cord clamping (within the first minutes after birth)]

Secondary outcome measures (1)

• Oxygen saturation (SpO₂) [Time frame: During delayed umbilical cord clamping (within the first minutes after birth)]

Eligibility criteria

Inclusion criteria

• The newborn must have been born at term (≥37 weeks)
• Born from a singleton pregnancy
• Born vaginally
• The newborn must have been born alive
• The newborn must have spontaneous breathing
• The 1-minute Apgar score must be ≥7
• The mother must be able to communicate with the research
• The mother must have volunteered to participate in the study and given informed consent

Exclusion criteria

• Meconium-stained or foul-smelling amniotic fluid
• Episiotomy (3rd and 4th degree) and medical intervention during labor (vacuum, dystocia interventions, etc.)
• Suspicion of congenital anomalies or genetic diseases in the newborn
• History of known chronic diseases in the mother or baby (diabetes, hypertension, epilepsy, thyroid disease, etc.)

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: Yes

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Single blind

Primary purpose

Supportive care

Study locations

Turkey (Türkiye) · 1 center

• Mersin University — Mersin

Identifiers

NCT: NCT07719751 · Mersin University 1

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗