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

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 measuresHaemoglobin 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.

Neonatal Outcome Following Cord Clamping After Onset of Spontaneous Respiration

“…Accumulating evidence suggests that CC beyond 30 to 60 seconds after birth is of benefit for most infants. [1][2][3][4][5][6][7] Observational studies in the 1960s and 1970s suggested an association between DCC and overtransfusion of the infant, causing polycythemia, hyperbilirubinaemia, and respiratory symptoms. [8][9][10] Other studies indicated that ECC prevented placental transfusion and resulted in more respiratory distress syndrome among preterm infants.…”

Avnavling ved fødsel – praksis ved norske fødeinstitusjoner

“…Answers pertaining to jaundice most likely reflect the fact that the effect of the timing of cord clamping on the prevalence of clinically significant jaundice remains somewhat unclear. However, there appear to be only marginal differences in the prevalence of clinically significant jaundice reported by studies that have compared large groups of infants after late vs. early cord clamping (1,4,6,17).…”

“…Experience and clinical studies show, however, that it is practically feasible to undertake an early blood-gas analysis from the umbilical cord without having to clamp it first (Figure 1). In this manner, the advantages of obtaining a placental transfusion with late cord clamping (27) can be combined with an early blood-gas analysis (9,17). Some Norwegian hospitals have already recommended this procedure (Ragnhild Støen, St. Olavs Hospital, personal communication).…”

“…It has been debated whether an increase in the circulating blood volume causes an increased prevalence of jaundice and/or polycythaemia. In term neonates, however, no (4,17) or only a slightly increased (1) risk of significant jaundice is reported after late clamping, while marginally elevated bilirubin values have been observed in premature infants, although without any need for phototherapy (6). Symptomatic polycythaemia appears not to increase after late clam-ORIGINAL ARTICLE ping of the umbilical cord (1,4).…”

“…Late clamping of the umbilical cord reduces the prevalence of anaemia in the neonatal period and improves the iron status of the infant during the first six months of life (1,4,17). It has been debated whether an increase in the circulating blood volume causes an increased prevalence of jaundice and/or polycythaemia.…”