Wait a minute? An observational cohort study comparing iron stores in healthy Swedish infants at 4 months of age after 10-, 60- and 180-second umbilical cord clamping

• Published in: BMJ open 2017, Vol.7 (12), p.e017215-e017215
• Main Authors: Askelöf, Ulrica, Andersson, Ola, Domellöf, Magnus, Fasth, Anders, Hallberg, Boubou, Hellström-Westas, Lena, Pettersson, Karin, Westgren, Magnus, Wiklund, Ingela E, Götherström, Cecilia
• Format: Article
• Language: English
• Subjects: Adult; Age; Altruism; Anemia; Anemia, Iron-Deficiency - blood; Anemia, Iron-Deficiency - prevention & control; Babies; birth; birth weight; blood; Blood banks; blood cell count; body mass; Bone marrow; child health; Cohort analysis; comparative study; Constriction; controlled study; deficiency; Delivery; Delivery, Obstetric; Female; ferritin; ferritin blood level; Ferritins; Ferritins - blood; Fetal Blood; Fetal Blood - metabolism; fetal medicine; fetus blood; follow up; gestational age; head circumference; hemoglobin; human; Humans; Infant; Infant Health; Infant, Newborn; Iron; Iron - blood; Iron - deficiency; iron deficiency anemia; iron storage; ligation; major clinical study; Male; Medicin och hälsovetenskap; metabolism; newborn; Observational studies; observational study; Obstetric; obstetric delivery; obstetric procedure; Obstetrics and Gynaecology; paediatrics; Parents & parenting; Parturition; Pediatrics; Pediatrik; Placenta; Postpartum Period; Pregnancy; Prospective Studies; prospective study; puerperium; randomized controlled trial; sex difference; stem cell; Stem Cells; Sweden; Systematic review; time factor; Time Factors; Tissue and Organ Harvesting; transplantation; Umbilical cord; Umbilical Cord - blood supply; umbilical cord clamping; university hospital; vacuum extraction; vaginal delivery; vascularization
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2017-017215

Background and objectiveUmbilical cord blood (UCB) is a valuable stem cell source used for transplantation. Immediate umbilical cord (UC) clamping is widely practised, but delayed UC clamping is increasingly advocated to reduce possible infant anaemia. The aim of this study was to investigate an intermediate UC clamping time point and to evaluate iron status at the age of 4 months in infants who had the UC clamped after 60 s and compare the results with immediate and late UC clamping.DesignProspective observational study with two historical controls.SettingA university hospital in Stockholm, Sweden, and a county hospital in Halland, Sweden.MethodsIron status was assessed at 4 months in 200 prospectively recruited term infants whose UC was clamped 60 s after birth. The newborn baby was held below the uterine level for the first 30 s before placing the infant on the mother’s abdomen for additional 30 s. The results were compared with data from a previously conducted randomised controlled trial including infants subjected to UC clamping at ≤10 s (n=200) or ≥180 s (n=200) after delivery.ResultsAfter adjustment for age differences at the time of follow-up, serum ferritin concentrations were 77, 103 and 114 µg/L in the 10, 60 and 180 s groups, respectively. The adjusted ferritin concentration was significantly higher in the 60 s group compared with the 10 s group (P=0.002), while the difference between the 60 and 180 s groups was not significant (P=0.29).ConclusionIn this study of healthy term infants, 60 s UC clamping with 30 s lowering of the baby below the uterine level resulted in higher serum ferritin concentrations at 4 months compared with 10 s UC clamping. The results suggest that delaying the UC clamping for 60 s reduces the risk for iron deficiency.Trial registration number NCT01245296.