Effect of delayed cord clamping on iron stores in infants born to anemic mothers: a randomized controlled trial. Effect of timing of umbilical cord clamping on iron status in Mexican infants: a randomised controlled trial. The early effects of delayed cord clamping in term infants born to Libyan mothers. A study of the relationship between the delivery to cord clamping interval and the time of cord separation. Oxford Midwives Research Group. Placental transfusion and hyperbilirubinemia in the premature. Effect of timing of cord clamping on the iron status of infants at 3 months. The effect of early versus late cord clamping on signs of respiratory distress. A randomized clinical trial of the Leboyer approach to childbirth. Delayed cord clamping and haemoglobin levels in infancy: a randomised controlled trial in term babies.
To study the effects of cord clamping on iron stores of infants born to anemic mothers at 3 months of age.
                Randomized controlled trial.
                Teaching hospital.
                Infants born to mothers with hemoglobin (Hb)<100 g/L were randomized at delivery to either immediate cord clamping (early group) or cord clamping delayed till descent of placenta into vagina (delayed group). The outcome measures were infant's hemoglobin and serum ferritin 3 months after delivery.
                There were 102 neonates randomized to early (n = 43) or delayed cord clamping (n = 59). The groups were comparable for maternal age, parity, weight and supplemental iron intake, infant s birth weight, gestation and sex. The mean infant ferritin and Hb at 3 months were significantly higher in the delayed clamping group (118.4 microg/L and 99 g/L) than in the early clamping group (73 microg/L and 88 g/L). The mean decrease in Hb (g/L) at 3 months adjusted for co-variates was significantly less in the delayed clamping group compared to the early clamping group (-1.09, 95% CI-1.58 to -0.62, p >0.001). The odds for anemia (<100 g/L) at 3 months was 7.7 (95% CI 1.84-34.9) times higher in the early compared to the delayed clamping group.
                Iron stores and Hb in infancy can be improved in neonates born to anemic mothers by delaying cord clamping at birth. Delayed clamping of the umbilical cord increases the infant's iron endowment at birth and haemoglobin concentration at 2 months of age. We aimed to assess whether a 2-minute delay in the clamping of the umbilical cord of normal-weight, full-term infants improved iron and haematological status up to 6 months of age.
                476 mother-infant pairs were recruited at a large obstetrics hospital in Mexico City, Mexico, randomly assigned to delayed clamping (2 min after delivery of the infant's shoulders) or early clamping (around 10 s after delivery), and followed up until 6 months postpartum. Primary outcomes were infant haematological status and iron status at 6 months of age, and analysis was by intention-to-treat. This study is registered with ClinicalTrials.gov, number NCT00298051.
                358 (75%) mother-infant pairs completed the trial. At 6 months of age, infants who had delayed clamping had significantly higher mean corpuscular volume (81.0 fL vs 79.5 fL 95% CI -2.5 to -0.6, p=0.001), ferritin (50.7 mug/L vs 34.4 mug/L 95% CI -30.7 to -1.9, p=0.0002), and total body iron. The effect of delayed clamping was significantly greater for infants born to mothers with low ferritin at delivery, breastfed infants not receiving iron-fortified milk or formula, and infants born with birthweight between 2500 g and 3000 g. A cord clamping delay of 2 minutes increased 6-month iron stores by about 27-47 mg.
                Delay in cord clamping of 2 minutes could help prevent iron deficiency from developing before 6 months of age, when iron-fortified complementary foods could be introduced. This study was conducted to evaluate the haematological effects of the timing of umbilical cord clamping in term infants 24 h after birth in Libya. Mother-infant pairs were randomly assigned to early cord clamping (within 10s after delivery) or delayed clamping (after the cord stopped pulsating). Maternal haematological status was assessed on admission in the delivery room. Infant haematological status was evaluated in cord blood and 24 h after birth. Bilirubin concentration was assessed at 24 h. 104 mother-infant pairs were randomized to delayed (n=58) or early cord clamping (n=46). At baseline the groups had similar demographic and biomedical characteristics, except for a difference in maternal haemoglobin, which was significantly higher in the early clamping group (11.7 g/dL, SD 1.3 g/dL versus 10.9 g/dL, SD 1.6 g/dL; P=0.0035). Twenty-four hours after delivery the mean infant haemoglobin level was significantly higher in the delayed clamping group (18.5 g/dL versus 17.1 g/dL; P=0.0005). No significant differences were found in clinical jaundice or plethora. Surprisingly, blood analysis showed that two babies in the early clamping group had total serum bilirubin levels (> 15 mg/dL) that necessitated phototherapy. There were no babies in the late clamping group who required phototherapy. Three infants in the delayed clamping group had polycythaemia without symptoms, for which no partial exchange transfusion was necessary. Delaying cord clamping until the pulsations stop increases the red cell mass in term infants. It is a safe, simple and low cost delivery procedure that should be incorporated in integrated programmes aimed at reducing iron deficiency anaemia in infants in developing countries. A randomised controlled trial of 554 women was carried out to compare the effects of late and early umbilical cord clamping on the time of cord separation. In addition data were collected on maternal and neonatal outcomes. There were no significant differences between the two groups in the duration of cord adherence and neonatal and maternal outcomes. There appeared to be a higher rate of jaundice in the late clamped group which did not reach statistical significance. There was an unexpectedly higher rate of breast feeding at home in the late clamped group which did reach statistical significance. Overall the trial provides no clear evidence for the benefit of early cord clamping (the current policy as part of the active management of the third stage in the UK) on the outcomes considered. nan To determine the effect of timing of cord clamping on iron stores of term infants at 3 months of age.
                Prospective randomized clinical trial.
                Tertiary hospital.
                107 term neonates born to mothers with uncomplicated pregnancies and with hemoglobin more than 10 g/dl.
                The 107 infants were randomized to either early (n = 48) or late (n = 59) clamping groups at the time of delivery. Outcome measures evaluated were serum ferritin and hemoglobin in the infant at 3 months age.
                The groups were comparable for maternal age, parity, weight, supplemental iron intake in pregnancy, infant's birth weight, gestation and sex. Maternal and cord ferritin and hemoglobin values at birth were comparable. The infant ferritin at 3 months were also similar.
                Iron stores at 3 months in term infants are not influenced by timing of cord clamping at birth. nan To examine the effects of the Leboyer method of delivery, we randomly assigned 56 women to either a Leboyer or a conventional delivery and used a variety of clinical and behavioral measures to assess the outcome in mother and child. No differences were noted in maternal or newborn morbidity, in infant behavior in the first hour of life, at 24 or 72 hours post partum, or at eight months of age; or in maternal perceptions of her infant and the experience of giving birth, except that eight months after delivery, mothers who had used the Leboyer method were more likely to say that the event had influenced their child's behavior (P = 0.05). Women who expected a Leboyer delivery had shorter active labors (P = 0.03), suggesting that psychologic factors (expectations) influence physical outcomes in perinatal medicine. Our results suggest that the Leboyer procedure has no advantage over a gentle, conventional delivery in influencing infant and maternal outcomes. This study was carried out to assess whether delaying umbilical cord clamping is effective in improving the haematological status of term infants living in a malaria-endemic area, and whether this is associated with complications in infants and mothers.
                We randomly assigned women delivering term babies in Mpongwe Mission Hospital, Zambia, to delayed cord clamping (DCC, n = 46) or immediate cord clamping (controls, n = 45) and followed their infants on a bi-monthly basis until the age of 6 months. We compared the haemoglobin (Hb) change from cord values and the proportion of anaemic infants. Secondary outcomes related to infant and maternal safety.
                Throughout the observation period infant Hb levels in both groups declined, but more rapidly in controls than in the DCC group [difference in Hb change from baseline at 4 months 1.1 g/dl, 95% confidence interval (CI) 0.2; 2.1]. By 6 months, this difference had disappeared (0.0 g/dl, 95% CI -0.9; 0.8). The odds ratio for iron deficiency anaemia in the DCC group at 4 months was 0.3 (95% CI 0.1; 1.0), but no differences were found between the groups at 6 months. No adverse events were seen in infants and mothers.
                Our findings indicate that DCC could help improve the haematological status of term infants living in a malaria-endemic region at 4 months of age. However, the beneficial haematological effect disappeared by 6 months. This simple, free and safe delivery procedure might offer a strategy to reduce early infant anaemia risk, when other interventions are not yet feasible.