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J Pediatr. 2018 Dec;203:266-272.e2. doi: 10.1016/j.jpeds.2018.06.006. Epub 2018 Jul 6.

Effects of Delayed Cord Clamping on 4-Month Ferritin Levels, Brain Myelin Content, and Neurodevelopment: A Randomized Controlled Trial.

Author information

1
College of Nursing, University of Rhode Island, Kingston, RI; Pediatrics, Alpert School of Medicine, Brown University, Providence, RI; Department of Pediatrics, Women and Infants Hospital of Rhode Island, Providence, RI.
2
College of Nursing, University of Rhode Island, Kingston, RI; Department of Pediatrics, Women and Infants Hospital of Rhode Island, Providence, RI.
3
Advanced Baby Imaging Lab, Memorial Hospital of Rhode Island, Pawtucket, RI; Department of Radiology, University of Colorado School of Medicine, Aurora, CO.
4
Waisman Center, University of Wisconsin, Madison, WI.
5
Department of Pediatrics, Women and Infants Hospital of Rhode Island, Providence, RI.
6
Advanced Baby Imaging Lab, Memorial Hospital of Rhode Island, Pawtucket, RI.
7
Pediatrics, Alpert School of Medicine, Brown University, Providence, RI; Department of Pediatrics, Women and Infants Hospital of Rhode Island, Providence, RI.

Abstract

OBJECTIVE:

To evaluate whether placental transfusion influences brain myelination at 4 months of age.

STUDY DESIGN:

A partially blinded, randomized controlled trial was conducted at a level III maternity hospital in the US. Seventy-three healthy term pregnant women and their singleton fetuses were randomized to either delayed umbilical cord clamping (DCC, >5 minutes) or immediate clamping (ICC, <20 seconds). At 4 months of age, blood was drawn for ferritin levels. Neurodevelopmental testing (Mullen Scales of Early Learning) was administered, and brain myelin content was measured with magnetic resonance imaging. Correlations between myelin content and ferritin levels and group-wise DCC vs ICC brain myelin content were completed.

RESULTS:

In the DCC and ICC groups, clamping time was 172 ± 188 seconds vs 28 ± 76 seconds (P < .002), respectively; the 48-hour hematocrit was 57.6% vs 53.1% (P < .01). At 4 months, infants with DCC had significantly greater ferritin levels (96.4 vs 65.3 ng/dL, P = .03). There was a positive relationship between ferritin and myelin content. Infants randomized to the DCC group had greater myelin content in the internal capsule and other early maturing brain regions associated with motor, visual, and sensory processing/function. No differences were seen between groups in the Mullen testing.

CONCLUSION:

At 4 months, infants born at term receiving DCC had greater ferritin levels and increased brain myelin in areas important for early life functional development. Endowment of iron-rich red blood cells obtained through DCC may offer a longitudinal advantage for early white matter development.

TRIAL REGISTRATION:

ClinicalTrials.gov: NCT01620008.

KEYWORDS:

delayed cord clamping; iron; myelin; placental transfusion; umbilical cord milking

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