Editorial

Abstract

INDIAN PEDIATRICS 747 VOLUME 52__SEPTEMBER 15, 2015 At any point in fetal life, approximately 30% of the fetus’ blood volume is circulating through the placenta where all respiratory and many metabolic functions occur. At birth, allowing this blood to be redistributed to the infant provides up to 50% more iron-rich red blood cells in the circulation [1]. These red blood cells contribute to higher iron stores in infancy [2]. Placental transfusion which facilitates this blood transfer is accomplished in one of three ways: delayed cord clamping (DCC); milking the umbilical cord (UCM) before separating it from the placenta; or clamping and cutting the umbilical cord and milking after cutting (CUCM). Most studies contrast these methods to immediate cord clamping (ICC), the dominant world-wide practice. In term infants, placental transfusion can result in increased iron stores during the first 6 months of life [2]. To date, ferritin, a marker of iron stores, has not been measured in early or late preterm infants in studies of placental transfusion. Measuring ferritin is important because adequate iron is essential for normal brain development, especially during the critical first year when the most rapid brain growth occurs. A recent study of 400 Swedish term infants demonstrated that DCC increased ferritin levels by 48% at 4 months of age. At 4 years of age, those children who had a placental transfusion had higher fine motor and social-emotional scores [3]. In this issue of Indian Pediatrics, Kumar, et al. [4] are the first to report ferritin levels in late preterm infants born between 32 and 36 weeks gestational age [4]. Using CUCM with three milkings, they found ferritin levels almost double at 6 weeks of age in infants who received C-UCM (n=91) when compared to infants (n=86) who received ICC. They also report significantly higher bilirubin levels and an increased need for phototherapy in the C-UCM group. This is in direct contrast to most recent studies on placental transfusion. These important findings suggest the need for further follow-up of these children to determine long-term developmental effects and weigh risks versus benefits. There is no meta-analysis for late preterm infants with placental transfusion. Only two other studies specifically address this age group. The first examined infants between 34-36 weeks (n=41) and compared a 3-minute delay versus ICC [5]. They found higher hemoglobin levels at 1 day and 10 weeks without any difference in jaundice [5]. Ranjit, et al. [6] randomized 94 infants between 30 and 366/7 weeks to either DCC (at least 2 minutes) or ICC. They found higher hematocrit and ferritin levels at 6 weeks of age. The DCC group had longer duration of phototherapy but no difference in the incidence of significant jaundice.