Delayed umbilical cord clamping reduces anaemia in high-risk infants

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Delaying umbilical cord clamping for 180 seconds in high-risk infants effectively reduced anaemia by eight and 12 months of age with minimal side effects, according to results of a randomised clinical trial.

‘A delay of umbilical cord clamping for more than three minutes improves infants’ iron stores in general, can protect against anaemia in communities where iron deficiency anaemia is common, and has earlier been shown to have favourable effects on developmental outcomes at four years of age, even in a well-nourished population,’ Ola Andersson, MD, PhD, of the department of women’s and children’s health at Uppsala University in Sweden.

Anaemia affects over 40% of all children aged five years or younger worldwide and is associated with long-term stunt growth and development. Iron deficiency is linked to anaemia and is responsible for anaemia in approximately 50% of children.

Previous research has shown clamping of the umbilical cord for three minutes in infants prevents iron deficiency for up to six months, but it has not been shown to prevent iron deficiency or anaemia in older infants, Andersson said. Approximately one-third of a child’s blood is in the placenta at birth, he added. If clamping of the umbilical cord is performed immediately, the blood will remain in the placenta and go to waste. However, if clamping is postponed for three minutes, most of the blood — which contains haemoglobin, highly rich in iron — can flow back to the child as an extra blood transfusion.

To test this, researchers randomly assigned 540 children (boys, n = 281; mean gestational age, 39.2 weeks), born at a large obstetrical hospital in Kathmandu, Nepal — where anaemia affects up to 70% of infants — to early cord clamping (less than 60 seconds; n = 270) or delayed cord clamping (longer than 180 seconds; n = 270).

Researchers conducted follow-up with infants at eight and 12 months of age, during which they took blood samples to evaluate anaemia (haemoglobin) and iron deficiency (ferritin). At eight months, 212 infants from the delayed clamping group and 188 from the early clamping group returned for blood sampling.

At 8 months of age, infants who underwent delayed clamping generally had greater haemoglobin levels compared with the early clamping group (10.4 g/dL vs. 10.2 g/dL; difference, 0.2 g/dL; 95% CI, 0.1-0.4).

The prevalence of anaemia was lower in the delayed clamping group compared with the early clamping group (n = 197 vs. 222; RR = 0.89; 95% CI, 0.81-0.98).

Further, the percentage of children who had iron deficiency at eight months of age decreased by more than 40% in the delayed clamping group (60 vs. 103; RR = 0.58; 95% CI, 0.44-0.77).

At 12 months, haemoglobin levels remained 0.3 g/dL (95% CI, 0.04-0.5) higher in the delayed clamping group, and the reduced risk for anaemia persisted in the delayed clamping group (RR = 0.91; 95% CI, 0.84-0.98).

These data equated to a number needed to treat of 12 (95% CI, 7-78).

‘If the intervention was implemented on a global scale, this could translate to five million fewer infants with anaemia at eight months of age, with particular public health significance in South Asia and sub-Saharan Africa, where the prevalence of anaemia is the highest,’ the researchers wrote.

For more information:

Ola Andersson, MD, PhD, can be reached at International Maternal and Child Health, Department of Women’s and Children’s Health, Uppsala University, SE-751 85 Uppsala, Sweden; email: ola.andersson@kbh.uu.se.

Written by Melinda Stevens. This story was sourced from the Healio website.

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