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Effect of Delayed Cord Clamping of Term Babies on Neurodevelopment at 12 Months: A Randomized Controlled Trial.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Child Health and Nutrition. Life Line Nepal, Kathmandu, Nepal.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Child Health and Nutrition. UNICEF, Hlth Sect, UN House, Lalitpur, Nepal.ORCID iD: 0000-0002-0541-4486
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Child Health and Nutrition.
Paropakar Matern & Womens Hosp, Kathmandu, Nepal.
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2019 (English)In: Neonatology, ISSN 1661-7800, E-ISSN 1661-7819, Vol. 115, no 1, p. 36-42Article in journal (Refereed) Published
Abstract [en]

Background: Delayed cord clamping (DCC) is associated with an improved iron status at 8 months, a reduction of anemia at 12 months, and an improved development at 4 years. Assessment of the development after DCC has not been performed earlier in a setting with a high prevalence of iron deficiency.

Objective: The aim of this paper was to investigate the effects of DCC compared to early cord clamping (ECC) on the development evaluated with the Ages and Stages Questionnaire (ASQ) at 12 months of age.

Method: We conducted a randomized controlled trial investigating the effect of DCC (≥180 s) versus ECC (≤60 s) in 540 full-term deliveries. Twelve months after delivery, the parents reported their infant’s development by ASQ. Infants having a score < 1 standard deviation (SD) under the mean score were considered “at risk” of affected neurodevelopment.

Results: At 12 months of age, 332 (61.5%) infants were assessed. Fewer children in the DCC group were “at risk” of having affected neurodevelopment measured by the ASQ total score, 21 (7.8%) versus 49 (18.1%) in the ECC group. The relative risk was 0.43 (0.26–0.71). Infants in the DCC group had higher mean total scores (SD), 290.4 (10.4) versus 287.2 (10.1), p = 0.01. Significantly fewer infants in the delayed group were “at risk” and had higher scores in the domains “communication”, “gross motor”, and “personal-social”. Conclusions: DCC after 3 min was associated with an improvement of the overall neurodevelopment assessed at 12 months of age as compared to infants in the group with cord clamping within 1 min.

Place, publisher, year, edition, pages
2019. Vol. 115, no 1, p. 36-42
Keywords [en]
Ages and Stages Questionnaire, Delayed umbilical cord clamping, Improved neurodevelopment
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:uu:diva-364661DOI: 10.1159/000491994ISI: 000456665100006PubMedID: 30278462OAI: oai:DiVA.org:uu-364661DiVA, id: diva2:1259755
Funder
Swedish Society of MedicineSwedish Society for Medical Research (SSMF)Available from: 2018-10-30 Created: 2018-10-30 Last updated: 2019-03-25Bibliographically approved
In thesis
1. Delayed cord clamping in Nepal-Evidence for implementation
Open this publication in new window or tab >>Delayed cord clamping in Nepal-Evidence for implementation
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aims of this thesis were to investigate effects of timing of umbilical cord clamping on newborn health, and on infant outcomes up to 12 months of age in a high-risk population and to explore the context of implementing changed umbilical cord clamping practices in Nepal.

A randomised controlled trial with 540 late preterm and term infants born by normal vaginal delivery was set up at a maternity hospital in Kathmandu, Nepal. Infants were enrolled in two parallel groups (1:1 ratio), randomised to early (ECC) (≤60 seconds) or delayed cord clamping (DCC) (≥180 seconds).

To get a deeper understanding of barriers and enablers for change in clinical practise in relation to cord clamping, a qualitative study with delivery staff was set up. Focus group discussions and key informant interviews were conducted at two major delivery hospitals in Kathmandu.

Paper I showed that DCC was an effective intervention to reduces anaemia at 8 and 12 months of age in a high-risk population, which may have major positive effects on infants’ health and development.

Paper II utilised the Ages and Stages Questionnaire (ASQ) to assess neurodevelopment in infants at 12 months of age. The result showed DCC was associated with an improvement of the overall neurodevelopment at 12 months of age as compared to infants in the ECC group.

Paper III showed that DCC was not associated with an increased risk of hyperbilirubinemia during the first day of life or risk of jaundice within 4 weeks compared with the ECC group.

Paper IV demonstrated how a positive attitude towards DCC and a will to rely on research evidence when striving to do good are facilitators of change in clinical practice. However, the participants in the study were hesitant to apply DCC due to lack of national or institutional protocols and formal training. Consequently, they were forced to take informal decisions and rely on alternate sources of information.

In conclusion, delaying umbilical cord clamping for 180 seconds is safe and associated with a significantly reduced risk of anaemia at 8 and 12 months which may have neurodevelopmental effects at a later age and is not associated with an increased risk of hyperbilirubinemia during the first days of life or risk of jaundice within 4 weeks of age. In order to change cord clamping practices to comply with evidence and policies health-care staff needs to be better supported by the governance structures of the health system, with clear and approved guidelines made available and coherent training and support.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2019. p. 66
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1557
Keywords
Attitude, Clinical Practice, Ferritin, Haemoglobin, Iron deficiency, Iron deficiency anaemia, Iron status, Jaundice, Neonatal hyperbilirubinemia, Newborn, Neurodevelopment, Randomized controlled trial, Umbilical cord clamping.
National Category
Medical and Health Sciences
Research subject
Medical Science
Identifiers
urn:nbn:se:uu:diva-379616 (URN)978-91-513-0611-7 (ISBN)
Public defence
2019-05-22, Rudbeckssalen, Akademiska sjukhuset, Rudbeck entréplan, C11, Uppsala, 09:15 (English)
Opponent
Supervisors
Funder
Swedish Research Council, 2014-04229The Swedish Foundation for International Cooperation in Research and Higher Education (STINT), PT2016-6639
Available from: 2019-04-26 Created: 2019-03-25 Last updated: 2019-06-18

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Rana, NishaKC, AshishMålqvist, MatsAndersson, Ola

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