Delaying the clamping of the umbilical cord for 3 minutes after delivery decreased anemia for as long as 8-12 months in a population at high risk for the disorder, according to a report published online Jan. 17 in JAMA Pediatrics.

If early (within 1 minute of birth) cord clamping is avoided after delivery, fetoplacental blood moves into the newborn, augmenting his or her blood volume by 30%-40%. This is known to increase iron stores and prevent iron deficiency for at least 6 months, but until now there has been little evidence of how long this beneficial effect persists, said Ashish KC, MD, PhD, of International Maternal and Child Health, Uppsala (Sweden) University and the United Nations Children’s Fund, Lalitpur, Nepal, and associates.

They performed a prospective randomized trial in Nepal, a low-income region with a high prevalence of anemia, comparing the two approaches in 540 deliveries during a 7-week period. A study surveillance officer attended all the births. In the delayed-clamping group (270 infants), the neonate was placed on the mother’s abdomen until the officer informed the nurse-midwife that 3 minutes had passed and the cord should be clamped. In the control group (270 infants), the officer informed the nurse-midwife as 60 seconds approached so the cord could be clamped, if she had not already done so.

The primary outcome measure – the hemoglobin level at 8 months of age – was a significant 0.2 g/dL higher after delayed clamping. Also, anemia was significantly less prevalent with delayed cord clamping (73.0% vs. 82.2%). This represents an 11% reduction in the risk of anemia and a 42% reduction in the risk of iron deficiency. “The relative risk for having iron deficiency anemia was 0.58, with a number needed to treat of 7,” Dr. KC and associates said (JAMA Ped. 2017 Jan 17. doi: 10.1001/jamapediatrics.2016.3971 ).

The benefits of delayed cord clamping persisted at 12 months of age; the mean hemoglobin was 0.3 g/dL higher in the delayed group. Anemia was less prevalent in the delayed clamping group; the relative risk was 0.91, the investigators said.

If this intervention were implemented worldwide, “this could translate to 5 million fewer infants with anemia at 8 months of age, with particular public health significance in South Asia and sub-Saharan Africa, where the prevalence of anemia is highest,” the investigators said. This study was supported by the Midwifery Society of Nepal, the Swedish Society of Medicine, the Little Child’s Foundation, the Swedish Society of Medical Research, and the United Nations Children’s Fund. Dr. KC and associates reported having no relevant financial disclosures.


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