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 Children with anemia and iron deficiency may have impaired nervous
system development, which affects cognitive and motor abilities and
behavior. Typically, they're treated with foods and supplements that
provide extra iron, but some previous research has suggested delayed
umbilical cord clamping may reduce the odds of iron deficiency by
giving babies a transfusion of iron-rich blood from the placenta.
For the current study, researchers examined data on 540 babies who
were randomly selected to have either delayed cord clamping at least
three minutes after birth or earlier clamping within one minute of
delivery.
After eight months, babies with delayed cord clamping were 11
percent less likely to have anemia and 42 percent less likely to
have iron deficiency than infants who got early cord clamping,
researchers report in JAMA Pediatrics.
"If a baby gets clamped early, it will not gain access to the part
of its own blood that is still in the placenta," said senior study
author Dr. Ola Andersson, a pediatrics researcher at Uppsala
University in Sweden.
"That extra blood could have protected the baby from anemia and iron
deficiency during its first year of life," Andersson added by email.
Iron deficiency is the most common and widespread nutritional
disorder in the world, according to the World Health Organization
(WHO). It is more common in developing nations, but it is also the
only nutritional deficiency that is widespread in industrialized
countries.
An estimated 2 billion people worldwide are anemic, mostly due to
iron deficiency. In the developing world, the risk of anemia is
compounded by a variety of infections that can lead to iron
deficiency such as malaria, HIV and hookworm infestation.
Treatment guidelines may need to change for more babies to get
delayed cord clamping, Andersson said.
Currently, the World Health Organization recommends waiting at least
one minute to do this, while the American Congress of Obstetricians
and Gynecologists advises a delay of 30 to 60 seconds after
delivery.
In the study, half of the babies randomly assigned to delayed
clamping didn't get this done until at least 192 seconds after
delivery. Half of the babies selected for early clamping had this
done no later than 32 seconds after birth.
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Among the subset of 400 babies who returned to the clinic for
evaluations at age 8 months, 73 percent of babies who got delayed
clamping had anemia, compared with 82 percent of infants in the
early clamping group.
At one year, 344 babies got assessed again, and anemia remained less
common in the delayed clamping group.
One limitation of the study is that many babies dropped out before
they could be assessed at 8 and 12 months of age, the authors note.
Another drawback is that many clinicians delivering babies clamped
the cord too soon for babies assigned to the delayed cord clamping
group.
Still, widespread use of this intervention could translate into 5
million fewer infants with anemia at age 8 months, the researchers
conclude. The biggest benefit would be seen in South Asia and
Sub-Saharan Africa where the prevalence of anemia is highest.
"The take home message is that a delay of umbilical cord clamping
for more than three minutes improves infants’ iron stores in
general, can protect against anemia in communities where iron
deficiency anemia is common, and has earlier been shown to have
favorable effects on developmental outcomes at 4 years of age even
in a well nourished population," Andersson said.
SOURCE: http://bit.ly/2jHdhwj JAMA Pediatrics, online January 17,
2017.
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