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Delaying cord clamping improves neurodevelopment at 4 years
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While no differences were observed in full-scale IQ between infants with delayed umbilical cord clamping vs. those with early umbilical cord clamping, delayed clamping resulted in improvements in fine-motor and social skills at age 4 — particularly among boys.
“Delaying umbilical cord clamping by 2 to 3 minutes after delivery allows fetal blood remaining in the placental circulation to be transfused back to the newborn,” Ola Andersson, MD, PhD, of Uppsala University in Sweden, and colleagues wrote. This process has been associated with improved iron status at 4 to 6 months of age.
“There is a lack of knowledge regarding the long-term effects and evidence of no harm, causing policymakers to be hesitant to make clear recommendations concerning delayed cord clamping in full-term infants,” the investigators wrote.
For the follow-up to a randomized trial conducted at a Swedish hospital during April 16, 2008 to May 21, 2010, Andersson and colleagues assessed the IQ, development and behavior of 263 children at age 4 years with the use of IQ tests, questionnaires and other assessments. Delayed cord clamping (n = 141) was considered to be 3 minutes or longer after delivery; early cord clamping (n = 122) was considered to be 10 seconds or less after delivery.
There were no differences in Wechsler Preschool and Primary Scale (WPPS) of Intelligence III scores between groups. Improvements were observed, however, among children with delayed cord clamping in adjusted mean differences (AMD) in the Ages and Stages Questionnaire (ASQ) personal-social domains (2.8; 95% CI, 0.8-4.7), fine-motor domains (2.1; 95% CI, 0.2-4) and the Strengths and Difficulties Questionnaire prosocial subscale (0.5; 95% CI, >0.0-0.9).
Compared with children with early cord clamping, fewer children with delayed cord clamping experienced results less than the cut-off in the ASQ fine-motor domain (11% vs. 3.7%; P = .02) and the Movement Assessment Battery for Children bicycle-trail task (MABC; 12.9% vs. 3.8%; P = .02).
Adjusted mean differences were significantly increased among boys who received delayed cord clamping for WPPS of Intelligence III processing-speed quotient (4.2; 95% CI, 0.8-7.6), MABC bicycle-trail task (0.8; 95% CI, 0.1-1.5), fine motor domains of the ASQ, Third Edition (4.7; 95% CI, 1-8.4) as well as personal-social domains of the ASQ (4.9; 95% CI, 1.6-8.3).
In an accompanying editorial, Heike Rabe, MD, PhD, of the Brighton and Sussex Medical School and University Hospitals, Brighton, England, and colleagues wrote: “Awareness of the benefits for all newborns continues to increase as more studies are published. While many physicians have incorporated delayed cord clamping into practice, there remains a hesitation to implement delayed cord clamping, particularly with full-term infants. As evidence of the safety benefits of delayed cord clamping are demonstrated, this hesitation should disappear.
“We applaud Andersson and colleagues for their persistence because their study closes the knowledge gap regarding the long-term safety of delayed cord clamping in healthy full-term newborns. Their important findings suggest that there is an absence of harm that lasts until 4 years of age.” – by Jennifer Southall
Disclosure: The researchers report no relevant financial disclosures.
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Ralph Green, MD, PhD, FRCPath
This is the latest installment from the longitudinal Swedish study of a cohort in whom the putative long-term effects of delayed vs. early umbilical cord clamping on neurodevelopment is systematically being examined. The central question is whether this simple difference in obstetrical practice might modulate differences in the iron birthright that would accrue to an infant through delayed vs. early clamping. That iron is important for more than just simply constituting the core of hemoglobin is now widely known. It also serves important functions in building brawn and brain. Giants in the field of iron metabolism like Clement Finch, MD, and his group in Seattle and Ernest Beutler, MD, at City of Hope laid the groundwork for our understanding that iron deficiency took its toll on tissues other than the bone marrow and that there were complications of iron deficiency beyond anemia. What comes from the latest chapter in the Swedish saga is that fine motor skills are enhanced even at age 4, particularly in boys, when their iron supply has been boosted through the practice of delayed cord clamping. The fact that actual iron status at this age showed no differences between the groups implies that the differential effects of iron supply must have occurred at a much earlier age, when iron supply to the developing brain was presumably more critical. That a difference of 3 minutes in the time that a clamp is applied to the umbilical vessels might have such a significant effect on neurodevelopmental outcome is remarkable.
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Rabe H, et al. JAMA Pediatr. 2015;doi:10.1001/jamapediatrics.2015.0431.
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