Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
BMC Pediatrics
Published in: BMC Pediatrics 1/2018

Open Access 01-12-2018 | Research article

Early versus delayed cord clamping in small for gestational age infants and iron stores at 3 months of age - a randomized controlled trial

Authors: Abhishek Chopra, Anup Thakur, Pankaj Garg, Neelam Kler, Kanwal Gujral

Published in: BMC Pediatrics | Issue 1/2018

Login to get access

Abstract

Background

Delayed cord clamping is the standard of care in infants not requiring resuscitation; however effects of cord clamping strategies have not been evaluated systematically in small for gestational age (SGA) infants. The primary objective was to compare effects of delayed cord clamping (DCC) and early cord clamping (ECC) on serum ferritin at 3 months in SGA infants born at ≥35 weeks. The secondary objectives were to compare hematological parameters, clinical outcomes in neonatal period and growth at 3 months of age.

Methods

All eligible infants with fetal growth restriction were randomized to two groups, DCC at 60 s or ECC group in which the cord was clamped immediately after birth.

Results

Total of 142 infants underwent randomization and subsequently 113 infants underwent definite inclusion. At 3 months, the median (IQR) serum ferritin levels were higher in DCC group, compared to ECC; 86 ng/ml (43.35–134.75) vs 50.5 ng/ml (29.5–83.5), p = 0.01. Fewer infants had iron deficiency in DCC group compared to ECC group; 9 (23.6%) vs 21 (47.7%), p = 0.03 [NNT being 4; 95% CI (2–25)].The proportion of infants with polycythemia was significantly higher in DCC group; 23 (41.81) % vs 12 (20.6%), p = 0.01. There was no difference in proportion of infants with symptomatic polycythemia or those who underwent partial exchange transfusions. Clinical outcomes and mortality were similar.

Conclusions

DCC improves iron stores in SGA infants ≥35 weeks at 3 months of age without increasing the risk of symptomatic polycythemia, need for partial exchange transfusions or morbidities associated with polycythemia.

Trial registration

Our trial was retrospectively registered on 29th May 2015 through Clinical trials registry India. Registration number: CTRI 2015/​05/​005828.
Literature
1.
2.
Leduc D, Senikas V, Lalonde AB, et al. Clinical practice obstetrics committee; Society of Obstetricians and Gynaecologists of Canada. Active management of the third stage of labour: prevention and treatment of postpartum hemorrhage. J Obstet Gynaecol Can. 2009;31:980–93.CrossRefPubMed
3.
Sweet DG, Carnielli V, Greisen G, et al. European Association of Perinatal Medicine. European consensus guidelines on the management of neonatal respiratory distress syndrome in preterm infants--2013 update. Neonatology. 2013;103:353–68.CrossRefPubMed
4.
Perlman JM, Wyllie J, Kattwinkel J, et al. Neonatal resuscitation chapter collaborators. Part 11:neonatal resuscitation: 2010 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Circulation. 2010;122:S516–38.CrossRefPubMed
5.
Linderkamp O, Nelle M, Kraus M, et al. The effect of early and late cord-clamping on blood viscosity and other hemorheological parameters in full-term neonates. Acta Paediatr. 1992;81:745–50.CrossRefPubMed
6.
McDonald SJ, Middleton P, Dowswell T, et al. Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. Cochrane Database Syst Rev. 2013;7:CD004074.
7.
Lozoff B, Jimenez E, Hagen J, et al. Poorer behavioral and developmental outcome more than 10 years after treatment for iron deficiency in infancy. Pediatrics. 2000;105:E51.CrossRefPubMed
8.
Patidar S, Shrivastava J, Agrawal A, et al. Assessment of iron status and red cell parameters in healthy full term small for gestational age neonates at birth. J Clin Neonatol. 2013;2:121–4.CrossRefPubMedPubMedCentral
9.
Mukhopadhyay K, Yadav RK, Kishore SS, et al. Iron status at birth and at 4 weeks in term small-for-gestation infants in comparison with appropriate-for-gestation infants. J Matern Fetal Neonatal Med. 2011;2:886–90.CrossRef
10.
Hadlock FP, Harrist RB, Martinez-Poyer J. In utero analysis of fetal growth: a sonographic weight standard. Radiology. 1991;181:129–33.CrossRefPubMed
11.
12.
13.
Shohat M, Merlob P, Reisner SH. Neonatal polycythemia: I. Early diagnosis and incidence relating to time of sampling. Pediatrics. 1984;73:7–10.PubMed
14.
Shohat M, Reisner SH, Mimouni F, et al. Neonatal polycythemia: II. Definition related to time of sampling. Pediatrics. 1984;73:11–3.PubMed
15.
Pappas A, Delaney-Black V. Differential diagnosis and management of polycythemia. Pediatr Clin N Am. 2004;51:1063–86.CrossRef
16.
Saarinen UM, Simes AA. Serum ferritin in assessment of iron nutrition in healthy infant. Acta Paediatr Scand. 1987;67:745–51.CrossRef
17.
American Academy of Pediatrics Subcommittee Hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics. 2004;114(1):297–316.CrossRef
18.
Geethanath RM, Ramji S, Thirupuram S, et al. Effect of timing of cord clamping on the iron status of infants at 3 months. Indian Pediatr. 1997;34:103–6.PubMed
19.
Lee AC, Katz J, Blencowe H, et al. CHERG SGA-preterm birth working group. National and regional estimates of term and preterm babies born small for gestational age in 138 low-income and middle-income countries in 2010. Lancet Glob Health. 2013;1:e26–36.CrossRefPubMedPubMedCentral
20.
Chaparro CM, Neufeld LM, Tena Alavez G, et al. Effect of timing of umbilical cord clamping on iron status in Mexican infants: a randomised controlled trial. Lancet. 2006;367:1997–2004.CrossRefPubMed
21.
Gupta R, Ramji S. Effect of DCC on iron stores in infants born to anemic mothers: a randomized controlled trial. Indian Pediatr. 2002;39:130–5.PubMed
22.
Andersson O, Hellström-Westas L, Andersson D, et al. Effect of delav versus early umbilical cord clamping on neonatal outcomes and iron status at 4 months: a randomised controlled trial. BMJ. 2011;343:d7157.CrossRefPubMedPubMedCentral
23.
Ohls RK. Developmental erythropoiesis. In: Polin RA, Fox WW, Abman SH, editors. Fetal and neonatal physiology. 4th ed. Philadelphia: Elseviers Saunders; 2011. p. 1495–520.CrossRef
24.
Wirth FH, Goldberg KE, Lubchenco LO. Neonatal hyperviscosity: I. Incidence. Pediatrics. 1979;63:833–6.PubMed
25.
Grajeda R, Pérez-Escamilla R, Dewey KG. Delayed clamping of the umbilical cord improves hematologic status of Guatemalan infants at 2 mo of age. Am J Clin Nutr. 1997;65:425–31.CrossRefPubMed
26.
Ceriani Cernadas JM, Carroli G, Pellegrinin L, et al. The effect of early and delayed umbilical cord clamping on ferritin levels in term infants at six months of life: a randomized controlled trial. Arch Argent Pediatr. 2010;108:201–8.PubMed
27.
Kaplan M. Neonatal jaundice and liver diseases. In: Martin RJ, Fanaroff AA, Walsh MC, editors. Diseases of the fetus and infant. 10th ed. Philadephia: Elsevier Saunders; 2015. p. 1618–75.
Metadata
Title
Early versus delayed cord clamping in small for gestational age infants and iron stores at 3 months of age - a randomized controlled trial
Authors
Abhishek Chopra
Anup Thakur
Pankaj Garg
Neelam Kler
Kanwal Gujral
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Pediatrics / Issue 1/2018
Electronic ISSN: 1471-2431
DOI
https://doi.org/10.1186/s12887-018-1214-8

Other articles of this Issue 1/2018

BMC Pediatrics 1/2018 Go to the issue

Research article

HIV diagnosis disclosure to infected children and adolescents; challenges of family caregivers in the Central Region of Ghana

Research article

Hypertriglyceridaemia in extremely preterm infants receiving parenteral lipid emulsions

Research article

Neonatal hypothermia and associated factors among neonates admitted to neonatal intensive care unit of public hospitals in Addis Ababa, Ethiopia

Research article

Occurrence of erythema migrans in children with Lyme neuroborreliosis and the association with clinical characteristics and outcome – a prospective cohort study

Research article

Prevalence and antibiotic susceptibility patterns of Shigella and Salmonella among children aged below five years with Diarrhoea attending Nigist Eleni Mohammed memorial hospital, South Ethiopia

Research article

Feasibility and utility of active case finding of HIV-infected children and adolescents by provider-initiated testing and counselling: evidence from the Laquintinie hospital in Douala, Cameroon