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Waiting to clamp the umbilical cord — NPR carefully balances discussion of benefits and harms

Delayed Umbilical Cord Clamping May Benefit Children Years Later

Our Review Summary

sleeping newborn babyThis story does a better job than a competing USA Today story at explaining why a delay in cutting the umbilical cord between newborn and Mom might give a modest boost to a child’s development four years later. Both stories describe a journal article that showed small improvements in fine-motor skills for children whose cords were left attached for three minutes compared to just ten seconds. This story provides more context and includes some limitations of the study on only 263 children, and discusses potential harms of waiting vs. immediate clamping. We’d like to have seen more numbers included in the description of benefits, and a discussion of why the high dropout rate in this study might have biased the results.

 

Why This Matters

Estimates are that one out of six babies born in the US suffers some anemia, or a low level of iron in their blood. Delaying of clamping the umbilical cord between mother and child might be a way to prevent that. It is already recommended for premature infants. However, this small study from Sweden shows only modest results in fine-motor skills for children four years later. The researchers themselves write that “larger studies” are necessary before all birth practices should be changed.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Applicable

The difference of slowing down the clamping of the newborn’s umbilical cord does not seem to add any cost to care for a delivery. The story might have talked about potential “savings” if widespread use of this new technique made iron-deficiency for babies less common in US. But any benefit would be difficult to quantify. We’ll rate it Not Applicable.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

This is a tough call. This story did put some context around the benefits — calling them “modestly higher scores in social skills and fine motor skills.” It also pointed out that only the boys showed “statistically significant improvement.” But we’d like to have seen some actual numbers (for example, 3.7% of delayed cord clamping children scored 2 standard deviations below average in fine motor skills compared to 11% in the early cord clamping group). The story could easily have massaged that technical language to make this understandable to an average reader. In addition, it might have added some nice color and helped readers to get a sense of the nature of the benefits if the article described the sorts of tasks the subjects were asked to do (e.g. threading beads).

Does the story adequately explain/quantify the harms of the intervention?

Satisfactory

Hooray for this story including two potential harms and reporting with experts outside of the study authors. The story calls the potential for harms “unclear” and that is one of way of giving the reader some balance even if there isn’t much information available. Both jaundice and polycythemia are listed as potential harms.

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

The story did a mostly thorough job of explaining what happened in this randomized controlled study and providing context regarding the study’s limitations. There’s more meat here than in the competing USA Today story. However, the description is misleading in a way that speaks to the quality of the evidence, and so we reluctantly rule this Not Satisfactory.

Here’s what’s wrong: The story says that “researchers randomly assigned half of 263 healthy Swedish full-term newborns to have their cords clamped more than three minutes after birth. The other half were clamped less than 10 seconds after birth.” That’s not entirely accurate. In fact, 400 children were randomized in the original study, 382 were invited to participate in the follow-up study, and only 263 were actually followed up 4 years later. That’s why the researchers caution in the study that there was a “relatively high” dropout rate of 31.2%. Because of that high dropout rate, the researchers noted that they “cannot exclude a possible bias in the overall development of the children whose parents chose to return for the follow-up…” This means that it’s possible that parents who returned for the follow-up 4 years later might be raising their kids differently than those who dropped out, and that those differences had some impact on the test scores. In other words, maybe the delayed cord-clamping 4 years ago wasn’t really cause of the better test scores. The story would have done well to alert readers to this possibility.

Does the story commit disease-mongering?

Satisfactory

There was no disease mongering.

Does the story use independent sources and identify conflicts of interest?

Satisfactory

The story made very good use of independent sources beyond the study authors.

Does the story compare the new approach with existing alternatives?

Satisfactory

There’s either early or late clamping, and the article describes both methods.

Does the story establish the availability of the treatment/test/product/procedure?

Not Satisfactory

Hypothetically, a delay in cord-clamping is something equally available to all those who deliver babies and their patients. But in the real world it’s different: A delay is only available to a woman if her doctor/health system decides to offer it (barring the role of patient advocacy). The story didn’t explore how common delayed cord-clamping is, or how willing doctors are to consider it. And unlike the competing USA Today story, it didn’t suggest that women might want to raise the issue with their doctors.

Does the story establish the true novelty of the approach?

Satisfactory

The delay in clamping is not novel. The story establishes that there have been earlier studies, but none that followed children for four years.

Does the story appear to rely solely or largely on a news release?

Satisfactory

The story does not rely solely on a news release.

Total Score: 6 of 9 Satisfactory

Comments (2)

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Tara Haelle

May 29, 2015 at 2:01 pm

Thanks for this feedback! I have a question re: quantifying the benefits. I nearly always quantify benefits or harms in my stories – except when I cannot think of a way to do it that won’t confuse the reader or make the information meaningless. That’s the situation I encountered here. I have never been able to figure out a way to explain what “standard deviations” above/below the norm means in layperson terms. I’ve even asked for help with this at conferences and on Twitter and Facebook, and I’ve yet to find something satisfactory. In this story, the sole thing preventing me from quantifying benefits as I usually do was that hang up. Any suggestions on that?

And good point on the loss to follow-up. I nearly included that information and was worried I would weigh the story down with numbers. It’s always a challenging balance. I don’t entirely agree regarding availability (having given birth to two kids and had these conversations with doctors myself), but I can see your point.

Reply

    Kevin Lomangino

    May 29, 2015 at 2:41 pm

    Thanks for your note Tara. Unfortunately, I do not have any ready suggestions for explaining standard deviation in a way that’s easy to understand, but I welcome input from others who might be able to help! For this particular study, I would probably have avoided getting into any of that, and merely described the percentage of kids who “scored below a cutoff indicating that they had below-normal fine motor skills” or something to that effect. A cop-out, maybe, but the best suggestion I can make for journalists on a deadline!

    And thanks for the comment and for engaging us in a discussion. I completely understand that you may have good reasons why you can’t/won’t address every criterion in every story. It’s a balancing act for sure!

    Kevin Lomangino
    Managing Editor

    Reply