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Comparison of two types of intervention to enhance placental redistribution in term infants: randomized control trial

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Abstract

The objective of the study was to compare the effect of umbilical cord milking (UCM) and delayed cord clamping (DCC) on hematological parameters (serum ferritin and hemoglobin) at 6 weeks of life in term neonates. It was a randomized controlled trail conducted at a teaching hospital in North India during August 2012 to August 2013. Babies born at >36 weeks of gestation were randomized in two groups, UCM and DCC (100 in each group). Umbilical cord milking was done after cutting and clamping the cord at 25 cm from the umbilicus. In DCC group, clamping was delayed by 60 to 90 s before cutting the cord. The baseline characteristics were comparable in the two groups. Mean serum ferritin (134.0 ng/ml [89.8]) and mean hemoglobin (11.0 gm/dl [2.4]) in umbilical cord milking group was comparable to mean serum ferritin (142.7 ng/ml [87.1]) and hemoglobin (11.3 gm/dl [2.6]) in DCC group at 6 weeks of age. There was no difference in hemodynamic status, cranial Doppler indices, and adverse neonatal outcomes among the two groups.

Conclusion: In term neonates, the DCC and UCM had comparable effect on hematological parameters at 6 weeks of life.

What is Known:

• Delayed cord blood clamping improves certain hematologic parameters for neonates, which is potentially important in populations with high rates of neonatal and childhood anemia, but that delayed cord blood clamping may not be feasible in clinical situations when neonatal resuscitation is urgent.

What is New:

• There is no significant difference in ferritin and hemoglobin levels at 6 weeks among term, Indian neonates who had UCM and DCC and that this study may give support to the practice of UCM in term deliveries when DCC is not feasible.

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Abbreviations

AAP:

American Academy of Pediatrics

AGA:

Appropriate for gestational age

CI:

Confidence interval

CTRI:

Clinical trial of India

DCC:

Delayed cord clamping

IDA:

Iron deficiency anemia

NIBP:

Noninvasive blood pressure

LMP:

Last menstrual period

NICU:

Neonatal intensive care unit

RBC:

Red blood cell

SGA:

Small for gestational age

SD:

Standard deviation

UCM:

Umbilical cord milking

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Conflict of interest

None of the authors have conflict of interest.

Funding

Partially funded by ICMR as thesis grant

Author’s contributions

PJ and SG collected, analyzed and interpreted the data for the study, and drafted the manuscript. AU, SG, DS, AG conceptualized and designed the study, analyzed the data and revised the manuscript. AU, KD, and SV cross checked the data and helped in review of literature. SV performed the statistical analysis of the data. AU supervised the study and shall act as the guarantor of the paper. Critical review was performed by all authors.

Author information

Authors and Affiliations

  1. Department of Pediatrics, LLRM Medical College, Meerut, India

    Prateek Jaiswal, Amit Upadhyay & Dharamveer Singh

  2. Department of Obstetrics, LLRM Medical College, Meerut, India

    Kirti Dubey

  3. Department of Micribiology, LLRM Medical College, Meerut, India

    Amit Garg

  4. Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India

    Sunil Gothwal

  5. Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India

    Sreeniwas Vishnubhatala

Authors
  1. Prateek Jaiswal
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  2. Amit Upadhyay
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  3. Sunil Gothwal
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  4. Dharamveer Singh
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  5. Kirti Dubey
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  6. Amit Garg
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  7. Sreeniwas Vishnubhatala
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Corresponding author

Correspondence to Amit Upadhyay.

Additional information

Communicated by Patrick Van Reempts

Implication for practice

UCM can be used in term neonates as a routine or in conditions where DCC is not feasible. In cases when the neonate requires resuscitation, then UCM can be done by the neonatal team attending the baby at delivery. Implication for research: Further studies with longer follow-up are needed to establish the sustainability of the advantage in hemoglobin and serum ferritin later in infancy. Other parameters like cerebral oxygenation and cerebral blood volume could also have been further evaluated. Also, superior vena caval flow indices and ECHO can be studied to see the impact of extra volume transfused on the cardiac function of the baby.

Presented as a PLATFORM presentation in clinical trial category at the annual meeting of the Pediatric Academic Societies Vancouver, BC, Canada, May 3, 2014. (Abstract#: 753875) Publication Number: 1445.1.

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Jaiswal, P., Upadhyay, A., Gothwal, S. et al. Comparison of two types of intervention to enhance placental redistribution in term infants: randomized control trial. Eur J Pediatr 174, 1159–1167 (2015). https://doi.org/10.1007/s00431-015-2511-y

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  • DOI: https://doi.org/10.1007/s00431-015-2511-y

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