Abstract
BackgroundDelayed cord clamping is the standard of care in infants not requiring resuscitation; however effects of cord clamping strategies have not been evaluated systematically in small for gestational age (SGA) infants. The primary objective was to compare effects of delayed cord clamping (DCC) and early cord clamping (ECC) on serum ferritin at 3 months in SGA infants born at ≥35 weeks. The secondary objectives were to compare hematological parameters, clinical outcomes in neonatal period and growth at 3 months of age.MethodsAll eligible infants with fetal growth restriction were randomized to two groups, DCC at 60 s or ECC group in which the cord was clamped immediately after birth.ResultsTotal of 142 infants underwent randomization and subsequently 113 infants underwent definite inclusion. At 3 months, the median (IQR) serum ferritin levels were higher in DCC group, compared to ECC; 86 ng/ml (43.35–134.75) vs 50.5 ng/ml (29.5–83.5), p = 0.01. Fewer infants had iron deficiency in DCC group compared to ECC group; 9 (23.6%) vs 21 (47.7%), p = 0.03 [NNT being 4; 95% CI (2–25)].The proportion of infants with polycythemia was significantly higher in DCC group; 23 (41.81) % vs 12 (20.6%), p = 0.01. There was no difference in proportion of infants with symptomatic polycythemia or those who underwent partial exchange transfusions. Clinical outcomes and mortality were similar.ConclusionsDCC improves iron stores in SGA infants ≥35 weeks at 3 months of age without increasing the risk of symptomatic polycythemia, need for partial exchange transfusions or morbidities associated with polycythemia.Trial registrationOur trial was retrospectively registered on 29th May 2015 through Clinical trials registry India. Registration number: CTRI 2015/05/005828.
Highlights
Delayed cord clamping is the standard of care in infants not requiring resuscitation; effects of cord clamping strategies have not been evaluated systematically in small for gestational age (SGA) infants
Forty four infants in early cord clamping (ECC) and 38 in delayed cord clamping (DCC) group were analyzed at 3 months for the primary outcome (Fig. 1)
At 3 months of age, the serum ferritin levels were higher in DCC group
Summary
Delayed cord clamping is the standard of care in infants not requiring resuscitation; effects of cord clamping strategies have not been evaluated systematically in small for gestational age (SGA) infants. The primary objective was to compare effects of delayed cord clamping (DCC) and early cord clamping (ECC) on serum ferritin at 3 months in SGA infants born at ≥35 weeks. Iron deficiency during the fetal or postnatal period can alter brain structure, neurochemistry and cognitive function. This can lead to long term cognitive and motor impairment, Chopra et al BMC Pediatrics (2018) 18:234 which cannot be corrected by iron supplementation later in life [7]
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