title: Effect of delayed versus early umbilical cord clamping on neonatal outcomes and iron status at 4 months: a randomised controlled trial.
abstract: OBJECTIVE
  To investigate the effects of delayed umbilical cord clamping, compared with early clamping, on infant iron status at 4 months of age in a European setting.
  
  
  METHODS
  Randomised controlled trial.
  
  
  METHODS
  Swedish county hospital.
  
  
  METHODS
  400 full term infants born after a low risk pregnancy.
  
  
  METHODS
  Infants were randomised to delayed umbilical cord clamping (≥ 180 seconds after delivery) or early clamping (≤ 10 seconds after delivery).
  
  
  METHODS
  Haemoglobin and iron status at 4 months of age with the power estimate based on serum ferritin levels. Secondary outcomes included neonatal anaemia, early respiratory symptoms, polycythaemia, and need for phototherapy.
  
  
  RESULTS
  At 4 months of age, infants showed no significant differences in haemoglobin concentration between the groups, but infants subjected to delayed cord clamping had 45% (95% confidence interval 23% to 71%) higher mean ferritin concentration (117 μg/L v 81 μg/L, P < 0.001) and a lower prevalence of iron deficiency (1 (0.6%) v 10 (5.7%), P = 0.01, relative risk reduction 0.90; number needed to treat = 20 (17 to 67)). As for secondary outcomes, the delayed cord clamping group had lower prevalence of neonatal anaemia at 2 days of age (2 (1.2%) v 10 (6.3%), P = 0.02, relative risk reduction 0.80, number needed to treat 20 (15 to 111)). There were no significant differences between groups in postnatal respiratory symptoms, polycythaemia, or hyperbilirubinaemia requiring phototherapy.
  
  
  CONCLUSIONS
  Delayed cord clamping, compared with early clamping, resulted in improved iron status and reduced prevalence of iron deficiency at 4 months of age, and reduced prevalence of neonatal anaemia, without demonstrable adverse effects. As iron deficiency in infants even without anaemia has been associated with impaired development, delayed cord clamping seems to benefit full term infants even in regions with a relatively low prevalence of iron deficiency anaemia. Trial registration Clinical Trials NCT01245296.
authors.affiliation: Department of Paediatrics, Hospital of Halland, Halmstad, SE-301 85 Halmstad, Sweden. ola.k.andersson@regionhalland.se
authors.forename: Ola
authors.initials: O
authors.lastname: Andersson
authors.forename: Lena
authors.initials: L
authors.lastname: Hellström-Westas
authors.forename: Dan
authors.initials: D
authors.lastname: Andersson
authors.forename: Magnus
authors.initials: M
authors.lastname: Domellöf
mesh_terms: D000328:Adult; D018798:Anemia, Iron-Deficiency / Q000097:blood / Q000517:prevention & control*; D000751:Anemia, Neonatal / Q000097:blood* / Q000517:prevention & control / Q000628:therapy; D003250:Constriction; D036861:Delivery, Obstetric; D004909:Erythrocyte Indices; D005260:Female; D005293:Ferritins / Q000097:blood*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D010789:Phototherapy; D011086:Polycythemia / Q000097:blood* / Q000628:therapy; D011247:Pregnancy; D013997:Time Factors; D014470:Umbilical Cord
chemical_list: D005293:Ferritins
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