Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 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

Judith S Mercer  1 , Debra A Erickson-Owens  2 , Sean C L Deoni  3 , Douglas C Dean 3rd  4 , Jennifer Collins  5 , Ashley B Parker  5 , Meijia Wang  5 , Sarah Joelson  6 , Emily N Mercer  6 , James F Padbury  7
Affiliations
Randomized Controlled Trial

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

Judith S Mercer et al. J Pediatr. 2018 Dec.

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.

PubMed Disclaimer

Figures

Figure 2
Figure 2
Correlation between myelin and ferritin at 4 months of age. Significance is indicated by the color scale on the right with yellow at P value of .01 and red indicating .05.
Figure 3
Figure 3
Group differences in myelin content between infants with DCC vs ICC by actual treatment. Significance is indicated by the color scale on the right with yellow at P value of .01 and red at a P value of .05. These colors represent areas in which myelin is greater in infants who had DCC compared with those who had ICC.
Figure 1
Figure 1
Infant brain study 4-month randomized cohort flowchart.
See this image and copyright information in PMC

Comment in

References

    1. Farrar D., Airey R., Law G.R., Tuffnell D., Cattle B., Duley L. Measuring placental transfusion for term births: weighing babies with cord intact. BJOG. 2011;118:70–75. - PubMed
    1. Yao A.C., Moinian M., Lind J. Distribution of blood between infant and placenta after birth. Lancet. 1969;2:871–873. - PubMed
    1. Andersson O., Hellstrom-Westas L., Andersson D., Domellof M. Effect of delayed versus early umbilical cord clamping on neonatal outcomes and iron status at 4 months: a randomized controlled trial. BMJ. 2011;343:d7157. - PMC - PubMed
    1. Ceriani Cernadas J.M., Carroli G., Pellegrini L., Ferreira M., Ricci C., Casas O. The effect of early and delayed umbilical cord clamping on ferritin levels in term infants at six months of life: a randomized, controlled trial [in Spanish] Arch Argent Pediatr. 2010;108:201–208. - PubMed
    1. Chaparro C.M., Neufeld L.M., Tena Alavez G., Eguia-Liz Cedillo R., Dewey K.G. Effect of timing of umbilical cord clamping on iron status in Mexican infants: a randomised controlled trial. Lancet. 2006;367:1997–2004. - PubMed

Publication types

MeSH terms

Associated data