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A randomized trial of delayed versus early cord clamping: iron status and neurodevelopment at 12 months of age
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden.
Department of Pediatrics, Hospital of Halland, Halmstad, Sweden.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Objectives: To investigate effects of delayed umbilical cord clamping, as compared to early, on iron status and infant development at 12 months of age.

Study design: Term infants (n = 382) were randomly assigned to delayed (≥180 sec) or early (≤10 sec) umbilical cord clamping. Follow up at 12 months of age included evaluation of iron status (ferritin, transferrin saturation, transferrin receptor, reticulocyte hemoglobin equivalent and mean cell volume) and parental assessment of neurodevelopment by the Ages and Stages Questionnaire.

Results: At 12 months 347 infants were assessed. The two randomization groups did not differ in iron status or in neurodevelopment; 13 had iron deficiency and only one infant had iron deficiency anemia. Predictors of ferritin levels were infant sex and ferritin in umbilical cord blood. Predictors of ASQ were infant sex and breastfeeding within one hour after birth. For both outcomes, being a boy was associated with lower results. Interaction analysis showed that delayed cord clamping was associated with a 5 points higher ASQ score among boys, but a 12 points lower score in girls, out of a maximum of 300 points.

Conclusions: Delayed cord clamping increases neonatal hemoglobin levels and improves iron status at four months of age, but does not affect ferritin levels or neurodevelopment assessed by ASQ in a selected population of healthy term born infants. However, minor effects on neurodevelopment may not be possible to demonstrate with the size of the study population and the chosen method for assessment. The current data indicate that effects of delayed cord clamping may differ according to infant sex and that boys may benefit more from delayed cord clamping than girls.

National Category
Medical and Health Sciences
Research subject
Pediatrics
Identifiers
URN: urn:nbn:se:uu:diva-198166OAI: oai:DiVA.org:uu-198166DiVA: diva2:615346
Available from: 2013-04-10 Created: 2013-04-10 Last updated: 2013-08-30
In thesis
1. Effects of Delayed versus Early Cord Clamping on Healthy Term Infants
Open this publication in new window or tab >>Effects of Delayed versus Early Cord Clamping on Healthy Term Infants
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aim of this thesis was to study maternal and infant effects of delayed cord clamping (≥180 seconds, DCC) compared to early (≤10 seconds, ECC) in a randomised controlled trial. Practice and guidelines regarding when to clamp the cord vary globally, and different meta-analyses have shown contradictory conclusions on benefits and disadvantages of DCC and ECC.

The study population consisted of 382 term infants born after normal pregnancies and randomised to DCC or ECC after birth. The primary objective was iron stores and iron deficiency at 4 months of age, but the thesis was designed to investigate a wide range of suggested effects associated with cord clamping.

Paper I showed that DCC was associated with improved iron stores at 4 months (45% higher ferritin) and that the incidence of iron deficiency was reduced from 5.7% to 0.6%. Neonatal anaemia at 2-3 days was less frequent in the DCC group, 1.2% vs. 6.3%. There were no differences between the groups in respiratory symptoms, polycythaemia, or hyperbilirubinaemia.

In paper II we demonstrated that DCC versus ECC was not associated with higher risk for maternal post partum haemorrhage and rendered a comparable ratio of valid umbilical artery blood gas samples.

In paper III, the Ages and Stages Questionnaire was used to assess neurodevelopment at 4 months. The total scores did not differ, but the DCC group had a higher score in the problem-solving domain and a lower score in the personal-social domain. Immunoglobulin G level was 0.7 g/L higher in the DCC group at 2–3 days, but did not differ at 4 months. Symptoms of infection up to 4 months were comparable between groups.

Finally, in paper IV, iron stores and neurodevelopment were similar between groups at 12 months. Gender specific outcome on neurodevelopment at 12 months was discovered, implying positive effects from DCC on boys and negative on girls.

We conclude that delaying umbilical cord clamping for 180 seconds is safe and associated with a significantly reduced risk for iron deficiency at 4 months, which may have neurodevelopmental effects at a later age.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2013. 66 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 893
Keyword
active management, birth, breast feeding, cord clamping, ferritin, growth, haemoglobin, human infant, infections, iron, iron deficiency, iron deficiency anemia, iron status, morbidity, neurodevelopment, randomised controlled trial, umbilical cord
National Category
Pediatrics
Research subject
Pediatrics
Identifiers
urn:nbn:se:uu:diva-198167 (URN)978-91-554-8647-1 (ISBN)
Public defence
2013-05-23, Rosénsalen, Ingång 95/96, Akademiska Barnsjukhuset, Uppsala, 09:30 (English)
Opponent
Supervisors
Available from: 2013-04-29 Created: 2013-04-10 Last updated: 2013-08-30Bibliographically approved

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