News

Delayed cord clamping linked to better neurodevelopmental outcomes

View on the News

It’s time to embrace delayed cord clamping

Early clamping of the cord was introduced in the past to avoid maternal hemorrhage without considering potential neonatal adverse effects. A meta-analysis by McDonald et al. (Cochrane Database Syst. Rev. 2013;7:CD004074) found no significant differences in postpartum hemorrhage rates when comparing early vs. late cord-clamping groups in five trials that included 2,260 women. In the current issue of JAMA Pediatrics, Andersson et al. describe the long-term follow-up of the same cohort of healthy term newborns at 4 years of age.

Until now, data on long-term follow-up of preterm and term infants who have been randomized to early vs. delayed cord clamping have been limited. While many physicians have incorporated delayed cord clamping into practice, there remains a hesitation to implement delayed cord clamping, particularly with term infants. As evidence of the safety and benefits of delayed cord clamping are demonstrated, this hesitation should disappear.

We applaud Dr. Andersson and colleagues for their persistence because their study closes the knowledge gap regarding the long-term safety of delayed cord clamping in healthy term newborns. Their important findings suggest that there is an absence of harm that lasts until 4 years of age.

Since 2000, no randomized clinical trials have substantiated prior concerns of symptomatic polycythemia or hyperbilirubinemia needing treatment. Physicians need to appreciate the significant risk of lower iron stores and iron-deficiency anemia on the early developing brain. The potential benefit of improving maternal and neonatal care by a simple no-cost intervention of delayed cord clamping should be championed by the international community beginning now and leading into the next decade.

These comments were excerpted from a commentary by Dr. Heike Rabe of the academic department of paediatrics at Brighton and Sussex Medical School and University Hospitals in England, and Debra A. Erickson-Owens, , Ph.D., and Judith S. Mercer, Ph.D., both of the College of Nursing at the University of Rhode Island, Kingston (JAMA Pediatr. 2015 May 26 [doi:10.1001/jamapediatrics.2015.0431]). The authors reported no relevant financial disclosures.


 

References

Delaying the clamping of the umbilical cord at least 3 minutes after birth appears to improve social and fine motor skills in children at age 4 years, a follow-up study showed.

No differences in IQ were found, however, between those with early vs. delayed cord clamping.

“The included children constitute a group of low-risk children born in a high-income country with a low prevalence of iron deficiency,” Dr. Ola Andersson of Uppsala (Sweden) University and her associates wrote (JAMA Pediatr. 2015 May 26 [doi:10.1001/jamapediatrics.2015.0358]). “Still, differences between the groups were found, indicating that there are positive, and in no instance harmful, effects from delayed cord clamping,” they added. “Delaying umbilical cord clamping by 2-3 minutes after delivery allows fetal blood remaining in the placental circulation to be transfused to the newborn.”

In the original trial, 382 term infants from low-risk pregnancies were randomized to have their umbilical cords clamped within 10 seconds after birth or else at least 3 minutes after birth at a Swedish county hospital between April 2008 and May 2010. Four years later, 263 children underwent IQ testing with the Wechsler Preschool and Primary Scale of Intelligence and motor skills testing with the Movement Assessment Battery for Children. In addition, parents filled out questionnaires regarding the children’s behavior and developmental stages.

Average IQ scores did not differ between the two groups, but fewer children in the delayed cord-clamping group had an immature pencil grip: 13.2% percent, compared with 25.6% of those who had immediate cord clamping. Further, 3.8% of children who had delayed clamping and 12.9% of children who had immediate clamping fell below average on another fine motor test (the bicycle-trail task).

“In girls, there were no differences between the groups for any of the assessments. An at-risk result in the bicycle-trail task was less prevalent in boys who received delayed cord clamping, compared with those who received early cord clamping (3.6% vs. 23.1%); findings were similar in the Ages and Stages Questionnaire, Third Edition, fine-motor domain (8.9% vs 23.6%),” Dr. Andersson and her associates wrote.

“The effect by sex is consistent with previous results from the same study population at 12 months,” they said, because past studies have shown lower iron stores in boys, compared with girls, at birth and in infancy.

The research was funded by the Regional Scientific Council of Halland, the Linnéa and Josef Carlsson Foundation, the Southern Health care Region, H.R.H. Crown Princess Lovisa’s Society for Child Care, Uppsala University, the Little Childs Foundation, and the Swedish Research Council for Health, Working Life, and Welfare. The authors reported no relevant financial disclosures.

Recommended Reading

PAS: Screen for postpartum depression during infant hospitalization
MDedge Pediatrics
PAS: Screen for postpartum depression during infant hospitalization
MDedge Pediatrics
Neonatal abstinence syndrome on the rise
MDedge Pediatrics
NASPAG: Migraines don’t always preclude combined OCs
MDedge Pediatrics
Active treatment of extremely preterm infants varies
MDedge Pediatrics
PAS: Getting a grip on glucokinase MODY
MDedge Pediatrics
Postpartum codeine use declines
MDedge Pediatrics
PAS: Supplemental iron during and after pregnancy affects infant behavior
MDedge Pediatrics
Food recalls highlight risk of listeriosis
MDedge Pediatrics
CDC: Tdap vaccine coverage during pregnancy is low
MDedge Pediatrics