A Hospital Policy Change Toward Delayed Cord Clamping is Effective in Improving Hemoglobin Levels and Anemia Status of 8-month-old Peruvian Infants

Gyorkos, Theresa W.; Maheu‐Giroux, Mathieu; Blouin, Brittany; Creed-Kanashiro, Hilary; Casapía, Martín; Aguilar, Eder; Silva, Hermánn; Joseph, Serene A.; Penny, Mary E.

doi:10.1093/tropej/fms012

Cited by 15 publications

(14 citation statements)

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“…These include higher mean hemoglobin levels, iron stores as well as reduced prevalence of iron deficiency anemia (Gyorkos et al [7]. Milking the umbilical cord five times at birth is also associated with a decreased risk for iron-deficiency anemia (Erickson-Owens et al [8])…”

Section: Introductionmentioning

confidence: 99%

Bridging the Gap between Evidence and Practice: A Systematic Review—When Is the Best Time to Clamp the Infant’s Umbilical Cord in Term Low-Risk Women?

Dillon¹,

Duvall²,

McGuire³

2014

OJN

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Historically, in midwifery and obstetric care, the umbilical cord was not usually clamped until all pulsation of the cord had ceased. This is now referred to as delayed cord clamping or DCC (not clamping umbilical cord before two minutes of life). During the last one hundred years with changes in the ways women give birth, especially the shift toward hospital based birth in the Western world, it became commonplace for the cord to be clamped within 20 -30 seconds of birth (immediate cord clamping or ICC). Authors have postulated various reasons for this shift in timing of umbilical cord clamping to include a possible decreased risk of postpartum hemorrhage, the need for resuscitation of the newborn and sampling of cord blood for stem cells and cord blood analysis. Recent evidence suggests that newborns (particularly in low-resourced settings) would benefit greatly from a policy of DCC with decreased risks of childhood anemia, subsequent sequelae and the need for supplementation. This systematic review examined recent literature from the last eight years using commonly used academic search engines with associated keywords. The results were carefully collated into a table of findings and outcomes.

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Section: Introductionmentioning

confidence: 99%

Bridging the Gap between Evidence and Practice: A Systematic Review—When Is the Best Time to Clamp the Infant’s Umbilical Cord in Term Low-Risk Women?

Dillon¹,

Duvall²,

McGuire³

2014

OJN

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“…The sample size calculation is, therefore, based on an expected effect size of 0.2 kg and a SD of 1.01 kg, a significance level (α) of 0.05 and a power (1-β) of 0.80. As informed by a previous study in the same hospital population, 41 the final sample size takes into account a 20% loss to follow-up. Based on the above specifications and a two-sided independent t test, we estimate that 1010 participants is the total sample size needed to declare that infant weight gain is different between intervention groups.…”

Section: Methods and Analysismentioning

confidence: 99%

Maternal Deworming Research Study (MADRES) protocol: a double-blind, placebo-controlled randomised trial to determine the effectiveness of deworming in the immediate postpartum period

et al. 2015

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IntroductionSoil-transmitted helminth infections are endemic in 114 countries worldwide, and cause the highest burden of disease among all neglected tropical diseases. The WHO includes women of reproductive age as a high-risk group for infection. The primary consequence of infection in this population is anaemia. During lactation, anaemia may contribute to reduced quality and quantity of milk, decreasing the duration of exclusive breastfeeding and lowering the age at weaning. To date, no study has investigated the effects of maternal postpartum deworming on infant or maternal health outcomes.Methods and analysisA single-centre, parallel, double-blind, randomised, placebo-controlled trial will be carried out in Iquitos, Peru, to assess the effectiveness of integrating single-dose 400 mg albendazole into routine maternal postpartum care. A total of 1010 mother-infant pairs will be randomised to either the intervention or control arm, following inhospital delivery and prior to discharge. Participants will be visited in their homes at 1, 6, 12 and 24 months following delivery for outcome ascertainment. The primary outcome is infant mean weight gain between birth and 6 months of age. Secondary outcomes include other infant growth indicators and morbidity, maternal soil-transmitted helminth infection and intensity, anaemia, fatigue, and breastfeeding practices. All statistical analyses will be performed on an intention-to-treat basis.Ethics and disseminationResearch ethics board approval has been obtained from the McGill University Health Centre (Canada), the Asociación Civil Impacta Salud y Educación (Peru) and the Instituto Nacional de Salud (Peru). A data safety and monitoring committee is in place to oversee study progression and evaluate adverse events. The results of the analyses will be published in peer-reviewed journals, and presented at national and international conferences.Trial registration numberClinicaltrials.gov: NCT01748929.

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“…Delayed cord clamping results in increased neonatal haemoglobin and ferritin concentrations after birth, without an increased risk of adverse health outcomes in the mother or infant, aside from some reports of an increased risk of polycythaemia (Hutton & Hassan 2007;McDonald et al 2013). These improvements in iron status and decreased risk of iron deficiency and anaemia last throughout early infancy (Andersson et al 2011;Mercer et al 2018), even to 8-12 months of age (Gyorkos et al 2012;Kc et al 2017). Furthermore, increased brain myelination at 4 months (Mercer et al 2018) and improved fine motor and social development at 4 years, but not 1 year (Andersson et al 2014;Andersson et al 2015), has been reported in infants randomised to delayed clamping.…”

Section: Delayed Clamping Of the Umbilical Cordmentioning

confidence: 99%

The neonatal period: A missed opportunity for the prevention of iron deficiency and its associated neurological consequences?

McCarthy

Kiely

2019

Nutrition Bulletin

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Iron deficiency is the most common micronutrient deficiency worldwide. Iron is essential for the development of multiple organ systems, most especially the developing brain. Iron deficiency, particularly during sensitive periods of brain development, such as in early childhood, is associated with long‐lasting adverse consequences for cognition, motor function and behaviour. Little consideration has been given to iron deficiency in newborn infants and its potential health consequences. Fetal iron accretion is compromised by pregnancy complications such as pre‐term birth and gestational diabetes mellitus, and our work has identified an increased risk of low iron stores at birth from maternal lifestyle factors such as smoking and obesity. Early‐life events, including Caesarean section delivery, further add to the cumulative risk of neonatal iron deficiency, which can persist throughout infancy into early childhood. While investigations into the long‐term neurological consequences of neonatal iron deficiency are limited, there is evidence of poorer memory, motor function and language ability in children born iron deficient. Recently, we also identified significant behavioural consequences of neonatal deficiency persisting from 2 to 5 years of age, with effects particularly apparent in ‘high‐risk’ children born to obese or smoking mothers or delivered by Caesarean section. Interventions targeting the fetal/neonatal period could therefore represent a key opportunity for the prevention of iron deficiency and its associated long‐term health consequences. A dual approach is required, comprising public health strategies targeting prevention, to improve health in women of reproductive age, and the development of screening strategies for the early detection of iron deficiency in newborn infants.

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A Hospital Policy Change Toward Delayed Cord Clamping is Effective in Improving Hemoglobin Levels and Anemia Status of 8-month-old Peruvian Infants

Cited by 15 publications

References 10 publications

Bridging the Gap between Evidence and Practice: A Systematic Review—When Is the Best Time to Clamp the Infant’s Umbilical Cord in Term Low-Risk Women?

Bridging the Gap between Evidence and Practice: A Systematic Review—When Is the Best Time to Clamp the Infant’s Umbilical Cord in Term Low-Risk Women?

Maternal Deworming Research Study (MADRES) protocol: a double-blind, placebo-controlled randomised trial to determine the effectiveness of deworming in the immediate postpartum period

The neonatal period: A missed opportunity for the prevention of iron deficiency and its associated neurological consequences?

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