A randomized controlled trial on delayed cord clamping and iron status at 3–5 months in term neonates held at the level of maternal pelvis

Abstract

Background: Delayed umbilical cord clamping (DCC) for two to three minutes after birth, results in substantial transfusion of blood from the placenta to the newborn, thus likely to improve iron status within the first months of life. However, optimal infant position during DCC in relation to mother's pelvis has not yet been determined and this maneuver has been suggested to have substantial risk of neonatal jaundice and cardiopulmonary compromise. Objective: To study the effect of DCC with the infant held at the level of mother's pelvis, compared to early cord clamping on: a) iron status at 3–5 months of age (primary outcome), b) hemoglobin and iron status in immediate postnatal period, and c) potential hazards on neonatal outcome. Methods: This randomized controlled trial was conducted on mother-infant pairs born at term by normal vaginal delivery following uncomplicated low risk pregnancies. Neonates were randomized to early cord clamping, done immediately after birth (≤15 seconds) and DCC (3 minutes after birth), starting from the time of shoulder delivery, with the baby held at the level of mother's pelvis. Both groups were evaluated for hematological parameters mainly, transferrin saturation and serum ferritin at 24 hours and then at 3–5 months postnatally. Results: A total of 180 mother-infants pairs were included; with 90 subjects in each group. At 3–5 months old, infants with DCC had significantly higher serum ferritin (430 vs. 228 ug/L, p < 0.001). Although hemoglobin (Hb) concentration did not differ between groups, DCC group had fewer cases with diagnosed with low serum ferritin (p < 0.001). At 24 hours postnatally, infants with DCC had significantly higher Hb (19.6 vs. 16.8 g/dl, p < 0.001) and hematocrit values (55.8 vs. 51.4%, p < 0.001) compared to early cord clamping group. None of the cases, in either group had respiratory distress or polycythemia in the immediate postnatal period with no significant difference in mean serum bilirubin level on comparing both groups. Conclusion: with the baby held at the level of mother's pelvis, DCC resulted in increased ferritin concentrations and reduced the prevalence of iron deficiency at 3–5 months of age, without demonstrable adverse neonatal effects.