Delayed cord clamping in South African neonates with expected low birthweight: a randomised controlled trial

Abstract

Abstractobjective To evaluate safety and haematological effects of delayed cord clamping (DCC) in infants with expected low birthweight born in a resource-poor setting.methods Randomised controlled trial involving pregnant women in early labour ≥18 years with intrapartum symphysal-fundal height ≤32 cm. Mothers were randomised for either early cord clamping (ECC, <30 s) or DCC (2-3 min after birth).results We included 104 vigorous infants born by vaginal delivery, of whom 39% had a birthweight <2500 g. Infant haemoglobin (Hb) levels 24 h after birth were significantly higher in the DCC group (18.0 g/dl vs 16.8 g/dl, P = 0.006). Despite successful placental transfusion, hyperbilirubinemia and hyperviscosity were not observed. Two months after birth, there were no differences in Hb between groups (9.9 g/dl vs 9.8 g/dl, P = 0.60), but the infants in the DCC group had better weight gain from baseline than those with ECC (2.2 kg vs 1.9 kg, P = 0.058).conclusions In this South African cohort of newborns with a subnormal distribution of birthweight delayed cord clamping was a safe procedure. Two months after birth the effect of DCC on Hb was not detectable anymore. DCC should be promoted in every singleton delivery in a resource-poor setting irrespective of the birthweight.

Area of exposure and treatment challenges of malaria in Eritrean migrants: a GeoSentinel analysis

“…This descriptive analysis of malaria cases ex Eritrea notified to GeoSentinel shows that the majority of cases were P. vivax (84%) and the median time to presentation after arrival in the host country was 39 days (for those for whom data were available). These results mirror the findings of single centre studies in Europe [ 1 – 4 , 8 , 10 – 12 , 32 ]. and Israel [ 2 ] and reflect a shift in imported malaria species dominance in Europe due to the changing demographics of migrants and asylum seekers.…”

“…In the Netherlands, during the period 2008–2015, P. vivax infections originated mainly from the Horn of Africa (214/372; 57.5%) and were largely attributable to asylum seekers from Eritrea [ 1 ]. In Milan, northern Italy, the proportion of P. vivax cases treated at a referral university hospital rose from 14.5% P. vivax in 2013 to 33.3% P. vivax in 2014 due mainly to malaria cases in Eritrean migrants [ 10 ]. In Sweden, a significant number of P. vivax cases in asylum-seekers from Eritrea led to the largest surge in imported malaria cases since computerized recording of malaria cases began in 1986 [ 4 ].…”

Early versus delayed umbilical cord clamping on maternal and neonatal outcomes

“…Interestingly, Ertekin et al [12] found that DCC up to 90–120 s increased the hemoglobin, hematocrit, and iron levels of infants significantly at the second month, but not at birth. Inversely, in a cohort of newborns with an expected low birth weight in South African, Tiemersma et al showed that the infant hemoglobin levels at 24 h after birth were significantly higher in the DCC group versus ECC group, while the effects of DCC on the infant hemoglobin levels were not detectable anymore at two months after birth [13].…”

“…In addition, despite successful placental transfusion, hyperbilirubinemia and hyperviscosity were not observed in South African neonates with expected low birth weight [13]. Garabedian et al [62] found that DCC resulted in no increase in severe hyperbilirubinemia in red blood cell alloimmunization.…”

“…To summarize, due to these inconsistent results among the studies [5, 10, 13, 37, 38, 67], a more comprehensive appraisal of delayed cord clamping is warranted.…”