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      Effect of delayed versus early umbilical cord clamping on neonatal outcomes and iron status at 4 months: a randomised controlled trial

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          Abstract

          Objective To investigate the effects of delayed umbilical cord clamping, compared with early clamping, on infant iron status at 4 months of age in a European setting.

          Design Randomised controlled trial.

          Setting Swedish county hospital.

          Participants 400 full term infants born after a low risk pregnancy.

          Intervention Infants were randomised to delayed umbilical cord clamping (≥180 seconds after delivery) or early clamping (≤10 seconds after delivery).

          Main outcome measures Haemoglobin and iron status at 4 months of age with the power estimate based on serum ferritin levels. Secondary outcomes included neonatal anaemia, early respiratory symptoms, polycythaemia, and need for phototherapy.

          Results At 4 months of age, infants showed no significant differences in haemoglobin concentration between the groups, but infants subjected to delayed cord clamping had 45% (95% confidence interval 23% to 71%) higher mean ferritin concentration (117 μg/L v 81 μg/L, P<0.001) and a lower prevalence of iron deficiency (1 (0.6%) v 10 (5.7%), P=0.01, relative risk reduction 0.90; number needed to treat=20 (17 to 67)). As for secondary outcomes, the delayed cord clamping group had lower prevalence of neonatal anaemia at 2 days of age (2 (1.2%) v 10 (6.3%), P=0.02, relative risk reduction 0.80, number needed to treat 20 (15 to 111)). There were no significant differences between groups in postnatal respiratory symptoms, polycythaemia, or hyperbilirubinaemia requiring phototherapy.

          Conclusions Delayed cord clamping, compared with early clamping, resulted in improved iron status and reduced prevalence of iron deficiency at 4 months of age, and reduced prevalence of neonatal anaemia, without demonstrable adverse effects. As iron deficiency in infants even without anaemia has been associated with impaired development, delayed cord clamping seems to benefit full term infants even in regions with a relatively low prevalence of iron deficiency anaemia.

          Trial registration Clinical Trials NCT01245296.

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          Most cited references36

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          PEDIATRICS

          Jose Ceriani Cernadas (1979)
          Article 0 comments Cited 198 times – based on 0 reviews     Review now
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            Prevalence of iron deficiency in the United States.

            Kevin C. Johnson, Lee Gunter, Ian M. Carroll … (1997)
            To determine the prevalence of iron deficiency and iron deficiency anemia in the US population. Nationally representative cross-sectional health examination survey that included venous blood measurements of iron status. Iron deficiency, defined as having an abnormal value for at least 2 of 3 laboratory tests of iron status (erythrocyte protoporphyrin, transferrin saturation, or serum ferritin); and iron deficiency anemia, defined as iron deficiency plus low hemoglobin. A total of 24,894 persons aged 1 year and older examined in the third National Health and Nutrition Examination Survey (1988-1994). Nine percent of toddlers aged 1 to 2 years and 9% to 11% of adolescent girls and women of childbearing age were iron deficient; of these, iron deficiency anemia was found in 3% and 2% to 5%, respectively. These prevalences correspond to approximately 700,000 toddlers and 7.8 million women with iron deficiency; of these, approximately 240,000 toddlers and 3.3 million women have iron deficiency anemia. Iron deficiency occurred in no more than 7% of older children or those older than 50 years, and in no more than 1% of teenage boys and young men. Among women of childbearing age, iron deficiency was more likely in those who are minority, low income, and multiparous. Iron deficiency and iron deficiency anemia are still relatively common in toddlers, adolescent girls, and women of childbearing age.
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              An overview of evidence for a causal relation between iron deficiency during development and deficits in cognitive or behavioral function.

              Joyce McCann, Bruce Ames (2007)
              This review, intended for a broad scientific readership, summarizes evidence relevant to whether a causal relation exists between dietary iron deficiency with (ID+A) or without (ID-A) anemia during development and deficits in subsequent cognitive or behavioral performance. An overview of expert opinion and major evidence in humans and animals is provided. Cognitive and behavioral effects observed in humans with ID-A and in animals with ID+/-A are provided in tables. The degree to which 5 conditions of causality are satisfied and whether deleterious effects of ID-A might be expected to occur are discussed. On the basis of the existing literature, our major conclusions are as follows. Although most of the 5 conditions of causality (association, plausible biological mechanisms, dose response, ability to manipulate the effect, and specificity of cause and effect) are partially satisfied in humans, animals, or both, a causal connection has not been clearly established. In animals, deficits in motor activity are consistently associated with severe ID+A, but adverse effects on performance in tests that target cognitive function have not been clearly shown. Resistance to iron treatment was observed in most trials of children 2 y of age and in adolescents with ID-A, evidence suggests cognitive or behavioral deficits; however, the surprisingly small number of studies conducted in either humans or animals prevents a thorough assessment.
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                Author and article information

                Contributors
                : Role: consultant in neonatology
                : Role: professor of perinatal medicine
                : Role: head of departments of paediatrics, obstetrics and gynaecology
                : Role: associate professor, head of paediatrics
                Journal
                Journal ID (nlm-ta): BMJ
                Journal ID (publisher-id): bmj
                Title: BMJ : British Medical Journal
                Publisher: BMJ Publishing Group Ltd.
                ISSN (Print): 0959-8138
                ISSN (Electronic): 1468-5833
                Publication date Collection: 2011
                Publication date (Print): 2011
                Publication date (Electronic): 15 November 2011
                Volume: 343
                Electronic Location Identifier: d7157
                Affiliations
                [1 ]Department of Paediatrics, Hospital of Halland, Halmstad, SE-301 85 Halmstad, Sweden
                [2 ]Department of Women’s and Children’s Health, Uppsala University, SE-751 85 Uppsala, Sweden
                [3 ]Department of Clinical Sciences, Paediatrics, Umeå University, SE-901 85 Umeå, Sweden
                Author notes
                Correspondence to: O Andersson ola.k.andersson@ 123456regionhalland.se
                Article
                Publisher ID: ando849935
                DOI: 10.1136/bmj.d7157
                PMC ID: 3217058
                PubMed ID: 22089242
                SO-VID: 1412f15d-c22d-44ef-853f-2d0437e16c32
                Copyright © © Andersson et al 2011
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.

                History
                Date accepted : 29 September 2011
                Categories
                Subject: Research
                Subject: Clinical Trials (Epidemiology)
                Subject: Malnutrition
                Subject: Pregnancy
                Subject: Reproductive Medicine
                Subject: Physiotherapy
                Subject: Sports and Exercise Medicine
                Subject: Metabolic Disorders

                ScienceOpen disciplines: Medicine
                Data availability:
                ScienceOpen disciplines: Medicine

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