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Delayed Cord Clamping at Birth Reduces Neonatal Anemia

Written by Pathways Magazine   
Thursday, 01 June 2006 00:00

Delayed cord clamping at birth reduces neonatal anemia, according to the results of a randomized trial reported in the April issue of Pediatrics.

“The umbilical cord is usually clamped immediately after birth,” write José M. Ceriani Cernadas, MD, from the Hospital Italiano de Buenos Aires in Argentina, and colleagues. “There is no sound evidence to support this approach, which might deprive the newborn of some benefits such as an increase in iron storage…Iron deficiency early in life may have pronounced central nervous system effects such as cognitive impairment; iron deficiency is also the main cause of anemia, one of the most serious conditions in childhood, especially in developing countries.”

In 2 obstetrical units in Argentina, 276 neonates born at term without complications to mothers with uneventful pregnancies were randomized to cord clamping within the first 15 seconds (group 1), at 1 minute (group 2), or at 3 minutes (group 3) after birth.

At 6 hours after birth, mean venous hematocrit values were 53.5% in group 1, 57.0% in group 2, and 59.4% in group 3. Statistical analyses showed equivalent results among groups because the hematocrit increase in neonates with late clamping was within the prespecified physiologic range.

The prevalence of anemia, defined as hematocrit less than 45%, was significantly lower in groups 2 and 3 than in group 1. The prevalence of hematocrit greater than 65% was similar in group 1 (4.4%) and in group 2 (5.9%) but significantly higher in group 3 (14.1%) than in group 1. Other neonatal outcomes and maternal postpartum hemorrhage were not significantly different in the 3 groups.

“Delayed cord clamping at birth increases neonatal mean venous hematocrit within a physiologic range,” the authors write. “Furthermore, this intervention seems to reduce the rate of neonatal anemia. This practice has been shown to be safe and should be implemented to increase neonatal iron storage at birth.”

The authors recommend controlled follow-up studies of the relationship between delayed cord clamping and the presence of anemia and iron status in infants.

“Another benefit of delayed clamping would be the increase of hematopoietic stem cells transfused to the newborn, which might play a role on different blood disorders and immune conditions,” the authors conclude. “The advantages of umbilical cord clamping at least at 1 minute after birth could decrease the prevalence of iron-deficiency anemia in the first year of life, especially in populations with limited access to health care.”

United Nations Children’s Fund (UNICEF) Argentina supported this study. The authors have disclosed no financial relationships.

Pediatrics. 2006;117:e779-e786

Pathways Issue 10 CoverThis article appeared in Pathways to Family Wellness magazine, Issue #10.

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