Effects of Delayed Vs Early Umbilical Cord Clamping on Infant Anemia

Ola Andersson, MD, PhD Department of Women’s and Children’s Health Uppsala University, Uppsala, Sweden

MedicalResearch.com Interview with:
Dr. Ola Andersson MD, PhD
Uppsala University,
Uppsala, Sweden

MedicalResearch.com: What is the background for this study?

Response: Anemia affects over 40% of all children under 5 years of age in the world. Anemia can impinge mental and physical performance, and is associated with long-term deterioration in growth and development. Iron deficiency is the reason for anemia in approximately 50% of the children.is. When clamping of the umbilical cord is delayed, ie after 3 minutes, iron deficiency up to 6 months of age can be prevented, but it has not been shown to prevent iron deficiency or anemia in older infants.

At birth, approximately 1/3 of the child’s blood is in the placenta. If clamping of the umbilical cord is done immediately (early cord clamping), the blood will remain in the placenta and go to waste (or can be stored in stem cell banks). If instead clamping is postponed for 3 minutes, most of the blood can flow back to the child as an extra blood transfusion, consisting of about one deciliter (1/2 cup) of blood, equivalent to about 2 liters (half a US gallon) of an adult. A blood donor leaves 0.4-0.5 liters of blood.

Blood contains red blood cells that contain hemoglobin. Hemoglobin carries oxygen to the tissues of the body. Hemoglobin contains a lot of iron, and the extra deciliter of blood may contain iron that corresponds to 3-4 months of the need for an infant.

The World Health Organization (WHO) recommends umbilical cord clamping at 1 minute or later, American College of Obstetricians and Gynecologists (ACOG) recommends umbilical cord clamping at 30-60 seconds or later.

MedicalResearch.com: What are the main findings?

Response: We randomized 540 children, born at a large obstetrical hospital in Kathmandu, Nepal, to early (≤ 60 seconds) or delayed cord clamping (≥180 seconds). In Nepal, approximately 70 % of infants up to one year of age have anemia. Follow-up included blood samples at 8 and 12 months of age, to evaluate anemia (hemoglobin) and iron deficiency (ferritin).At the age of 8 months the incidence of anemia was reduced by 9% among the Nepalese infants and still at 12 months of age 8% fewer infants were anemic. The children in the delayed cord clamping group generally had higher hemoglobin values, and the percentage of children who had iron deficiency at 8 months of age decreased significantly, more than 40%.

MedicalResearch.com: What should readers take away from your report?

Response: A delay of chttps://medicalresearch.com/pediatrics/delayed-umbilical-cord-clamping-in-preterm-infants-may-reduce-complications-and-need-for-transfusions/16703/ for more than three minutes improve infants iron stores in general, can protect against anaemia in communities where iron deficiency anaemia is common, and has earlier been shown to have favorable effects on developmental outcomes at 4 years of age, even in a well nourished population.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: Further follow-up studies will be required to evaluate the effect of delayed cord clamping on neurodevelopmental milestones in pre-school and school children. Additional research may be needed to evaluate if the optimal time of cord clamping may be even later than 180 seconds, i.e. at the delivery of the placenta. Furthermore, in this study, the infant was put skin-to-skin on the mother’s abdomen immediately after birth, but also in this handling different approaches need evaluation.

MedicalResearch.com: Is there anything else you would like to add?

Response: The major earthquakes in Nepal occurred in the midst of the trial, in May 2015. It was difficult to reach all the infants for blood sampling at 8 and 12 months of age. At eight months 3/4 (74%) and at 12 months of age just under two thirds (62%) were assessed. We had anticipated these problems and had therefore 188 additional children included in the study from the beginning.

More than 1/5 (23%) of the infants randomized to delayed cord clamping were still clamped early. Their results were counted among the delayed clamped infants according to “intention to treat”. If we exclude them, the beneficial effects of delayed cord clamping become even clearer.

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Effects of Delayed Umbilical Cord Clamping vs Early Clamping on Anemia in Infants at 8 and 12 Months
Ashish KC MD, PhD, Nisha Rana RN, MPH, Mats Målqvist MD, PhD, Linda Jarawka Ranneberg MD, Kalpana Subedi MD, Ola Andersson MD, PhD

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on January 17, 2017 by Marie Benz MD FAAD