A randomized controlled trial on delayed cord clamping and iron status at 3–5 months in term neonates held at the level of maternal pelvis

Al-Tawil, Mohammed; Abdel-Aal, Mohammed Reda; Kaddah,

doi:10.3233/npm-1263112

Cited by 19 publications

(14 citation statements)

References 27 publications

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“…This may be an indication of the positive effects of DCC in terms of preventing anemia in the neonatal period. These results were similar to those of previous studies that found a significantly higher hematocrit with DCC [ 21 , 31 ]. One study suggested that the effects lasted 2 months [ 31 ].…”

Section: Discussionsupporting

confidence: 93%

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Effects of timing of umbilical cord clamping on preventing early infancy anemia in low-risk Japanese term infants with planned breastfeeding: a randomized controlled trial

Shinohara

Kataoka

Yaju

2021

matern health, neonatol and perinatol

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Background Japanese infants have relatively higher risk of anemia and neonatal jaundice. This study aimed to assess the effects of delayed cord clamping (DCC) on the incidence of anemia during early infancy in low-risk Japanese term infants with planned exclusive breastfeeding for 4 months. This study also aimed to explore the effects of DCC on neonatal jaundice. Methods We conducted an open-label, parallel-arm, multicenter randomized controlled trial of DCC (clamping the cord after more than a minute or pulsation stops) vs. early cord clamping (ECC; clamping the cord within 15 s) at one birth center and two clinics in Japan. Low-risk pregnant women planning to have a vaginal birth and to exclusively breastfeed and term singleton infants delivered in cephalic presentation were included in this study. The primary outcome was spectrophotometric estimation of hemoglobin at 4 months. Secondary outcomes were anemia incidence at 4 months, four outcomes related to neonatal jaundice, hematocrit levels, and related outcomes. Results Overall, 150 pregnant women were recruited. Participants (N = 138) were randomly allocated to two groups (DCC n = 68, ECC n = 70). There were no significant differences between the two groups in spectrophotometric estimation of hemoglobin at 4 months: mean difference = 0.1 g/dL, 95% confidence interval − 0.14, 0.35, DCC 12.4 g/dL, ECC 12.3 g/dL. Only the hematocrit levels on days 3 to 5 were significantly higher in the DCC group than in the ECC group: DCC 57.0%, ECC 52.6%, mean difference = 4.4, 95% confidence interval 2.61, 6.20. There were no significant differences in other secondary outcomes, including outcomes related to neonatal jaundice. Conclusion Among low-risk Japanese term infants with planned exclusive breastfeeding, DCC showed no significant effects on spectrophotometric hemoglobin levels at 4 months compared with ECC. We observed significantly higher hematocrit levels on days 3 to 5 in infants who underwent DCC, while these levels were within the normal range. Jaundice outcomes remained similar to those of infants who underwent ECC. Although a larger sample size is required to assess the effects of cord clamping on neonatal jaundice, DCC may prevent anemia in newborn infants. Trial registration UMIN-CTR; UMIN000022573, 06/01/2016 - retrospectively registered, https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000023056

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Section: Discussionsupporting

confidence: 93%

“…We choose SpHb because it has been reported to correlate with serum Hb [ 19 ] and it is a non-invasive method in neonates to collect data. In previous study, differences have been reported between ECC and DCC groups using serum Hb [ 21 , 24 ], but it was not appropriate index for this study due to its invasive nature.…”

Section: Discussionmentioning

confidence: 99%

Effects of timing of umbilical cord clamping on preventing early infancy anemia in low-risk Japanese term infants with planned breastfeeding: a randomized controlled trial

Shinohara

Kataoka

Yaju

2021

matern health, neonatol and perinatol

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“…They confirmed that there were no statistical significant differences between the studied groups (immediate cord clamping, 1 minute and 2 minutes delayed cord clamping groups) as regard bilirubin level and need for phototherapy. Second, Al-Tawil et al [56] Who had conducted "a randomized controlled trial on DCC and iron status at 3-5 months in term neonates held at the level of maternal pelvis". They showed that serum bilirubin level didn't differ significantly between neonates experienced ECC or DCC.…”

Section: Discussionmentioning

confidence: 99%

Effects of Deferred Versus Early Umbilical Cord Clamping on Maternal and Neonatal Outcomes

Elgzar¹,

Ibrahim²,

Elkhateeb³

2017

AJNR

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Background: Recent protocol proposed by the World Health Organization to manage the third stage of labour replaced the early cord clamping by deferred cord clamping to induce numerous neonatal benefits. But this practice is still resisted in most of the Arab countries. The aim of this study was to evaluate the effectiveness of deferred versus early umbilical cord clamping on maternal and neonatal outcomes. Methods: A quasi experimental research design was utilized. The study was conducted at labour unit in Damanhour National Medical Institute. Sample: A convenience sample of 150 parturient women undergoing normal vaginal delivery were randomly divided in two groups; deferred cord clamping (n= 75) and early cord clamping (n= 75). Tools: Three tools were used for data collection; 1) Structured interview schedule to collect data about the women' demographic characteristics and reproductive history. 2) Maternal outcomes assessment sheet. 3) Neonatal outcomes assessment sheet to assess the immediate and late neonatal outcomes. Results: There were no statistically significant differences (P > 0.05) between deferred and early cord clamping groups in relation to the maternal risk for post-partum hemorrhage, duration of third stage of labour and the need for manual removal of the placenta. Furthermore, a highly statistically significant differences (p < 0.001) were observed regarding neonatal hemoglobin, hematocrit, and red blood cells between the two groups. The mean total bilirubin level was significantly higher (P < 0.05) in the deferred cord clamping group than early cord clamping group. Conclusion: The study concluded that deferred umbilical cord clamping did not increase the risk of maternal post-partum hemorrhage, duration of third stage of labour or the need for manual removal of the placenta. Also, deferred cord clamping significantly increased neonatal hemoglobin, hematocrit, and red blood cells level without serious elevation in the total bilirubin level as it was still in the low intermediate risk or below 75 th percentile. Recommendation: Institutionalization of deferred cord clamping in all governmental hospitals and medical educational settings through providing policies, procedures and guidelines regarding this practice. This could significantly improve the intra-natal care for the neonate without harmful consequences for the mother.

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“… Transferrin saturation over the neonatal period. (A) Full-term neonates: α shows the weighted mean (95% CI) for all studies seen in Supplemental Figure 2A; β, γ, and δ show Prentice et al ( 99 ); χ shows Al-Tawil et al ( 102 ); ε shows Balogh et al ( 94 ); ϕ shows Andersson et al ( 103 ); η shows Milman et al ( 39 ); ι shows Kitajima et al ( 104 ); φ shows Yamada and Leone ( 105 ). (B) Preterm neonates: α shows the weighted mean (95% CI) for all studies seen in Supplemental Figure 2B; β shows Lackmann et al ( 106 ); χ shows Celik et al ( 107 ); δ shows Yamada and Leone ( 105 ); ε shows Kitajima et al ( 104 ).…”

Section: Resultsmentioning

confidence: 99%

Hepcidin, Serum Iron, and Transferrin Saturation in Full-Term and Premature Infants during the First Month of Life: A State-of-the-Art Review of Existing Evidence in Humans

Cross

Prentice

Cerami

2020

Current Developments in Nutrition

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Neonates regulate iron at birth and in early postnatal life. We reviewed literature from PubMed and Ovid Medline containing data on umbilical cord and venous blood concentrations of hepcidin, iron and transferrin saturation (TSAT) in human neonates from 0–1 month of age. Data from 59 studies were used to create reference ranges for hepcidin, iron and TSAT for full-term neonates over the first month of life. In full-term neonates, venous hepcidin increases 2–3-fold over the first month of life (to reach 61.1 ng/mL; CI: 20.1–102.0 ng/mL) compared to umbilical cord blood (29.7 ng/mL; CI: 21.1–38.3 ng/mL). Cord blood has high levels of serum iron (28.5 μmol/L; CI: 26.0–31.1 μmol/L) and TSAT (51.7%; CI: 46.5–56.9%). Following a short-lived immediate postnatal hypoferremia, iron and TSAT rebounded to approximately half the levels in the cord by the end of the first month. There was insufficient data to formulate reference ranges for preterm neonates.

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A randomized controlled trial on delayed cord clamping and iron status at 3–5 months in term neonates held at the level of maternal pelvis

Cited by 19 publications

References 27 publications

Effects of timing of umbilical cord clamping on preventing early infancy anemia in low-risk Japanese term infants with planned breastfeeding: a randomized controlled trial

Effects of timing of umbilical cord clamping on preventing early infancy anemia in low-risk Japanese term infants with planned breastfeeding: a randomized controlled trial

Effects of Deferred Versus Early Umbilical Cord Clamping on Maternal and Neonatal Outcomes

Hepcidin, Serum Iron, and Transferrin Saturation in Full-Term and Premature Infants during the First Month of Life: A State-of-the-Art Review of Existing Evidence in Humans

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