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- Kc, Ashish, 1982-, et al.
(författare)
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Effect of timing of umbilical cord clamping on anaemia at 8 and 12 months and later neurodevelopment in late pre-term and term infants : a facility-based, randomized-controlled trial in Nepal.
- 2016
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Ingår i: BMC Pediatrics. - : Springer Science and Business Media LLC. - 1471-2431. ; 16
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Delayed cord clamping at birth has shown to benefit neonates with increased placental transfusion leading to higher haemoglobin concentrations, additional iron stores and less anaemia later in infancy, higher red blood cell flow to vital organs and better cardiopulmonary adaptation. As iron deficiency in infants even without anaemia has been associated with impaired development, delayed cord clamping seems to benefit full term infants also in regions with a relatively low prevalence of iron deficiency anaemia. In Nepal, there is a high anaemia prevalence among children between 6 and 17 months (72-78 %). The objective of the proposed study is to evaluate the effects of delayed and early cord clamping on anaemia (and haemoglobin level) at 8 and 12 months, ferritin at 8 and 12 months, bilirubin at 2-3 days, admission to Neonatal Intensive Care Unit (NICU) or special care nursery, and development at 12 and 18-24 months of age.METHODS/DESIGN: A randomized, controlled trial comparing delayed and early cord clamping will be implemented at Paropakar Maternity and Women's Hospital in Kathmandu, Nepal. Pregnant woman of gestational age 34-41 weeks who deliver vaginally will be included in the study. The interventions will consist of delayed clamping of the umbilical cord (≥180 s after delivery) or early clamping of the umbilical cord (≤60 s). At 8 and 12 months of age, infant's iron status and developmental milestones will be measured.DISCUSSION: This trial is important to perform because, although strong indications for the beneficial effect of delayed cord clamping on anaemia at 8 to 12 months of age exist, it has not yet been evaluated by a randomized trial in this setting. The proposed study will analyse both outcome as well as safety effects. Additionally, the results may not only contribute to practice in Nepal, but also to the global community, in particular to other low-income countries with a high prevalence of iron deficiency anaemia.
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| 2. |
- KC, Ashish, 1982-, et al.
(författare)
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Effects of Delayed Umbilical Cord Clamping vs Early Clamping on Anemia in Infants at 8 and 12 Months : A Randomized Clinical Trial
- 2017
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Ingår i: JAMA pediatrics. - : American Medical Association (AMA). - 2168-6203 .- 2168-6211. ; 171:3, s. 264-270
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Tidskriftsartikel (refereegranskat)abstract
- Importance: Delayed umbilical cord clamping has been shown to improve iron stores in infants to 6 months of age. However, delayed cord clamping has not been shown to prevent iron deficiency or anemia after 6 months of age.Objective: To investigate the effects of delayed umbilical cord clamping, compared with early clamping, on hemoglobin and ferritin levels at 8 and 12 months of age in infants at high risk for iron deficiency anemia.Design, Setting, and Participants: This randomized clinical trial included 540 late preterm and term infants born vaginally at a tertiary hospital in Kathmandu, Nepal, from October 2 to November 21, 2014. Follow-up included blood levels of hemoglobin and ferritin at 8 and 12 months of age. Follow-up was completed on December 11, 2015. Analysis was based on intention to treat.Interventions: Infants were randomized to delayed umbilical cord clamping (≥180 seconds after delivery) or early clamping (≤60 seconds after delivery).Main Outcomes and Measures: Main outcomes included hemoglobin and anemia levels at 8 months of age with the power estimate based on the prevalence of anemia. Secondary outcomes included hemoglobin and anemia levels at 12 months of age and ferritin level, iron deficiency, and iron deficiency anemia at 8 and 12 months of age.Results: In this study of 540 infants (281 boys [52.0%] and 259 girls [48.0%]; mean [SD] gestational age, 39.2 [1.1] weeks), 270 each were randomized to the delayed and early clamping groups. At 8 months of age, 212 infants (78.5%) from the delayed group and 188 (69.6%) from the early clamping group returned for blood sampling. After multiple imputation analysis, infants undergoing delayed clamping had higher levels of hemoglobin (10.4 vs 10.2 g/dL; difference, 0.2 g/dL; 95% CI, 0.1 to 0.4 g/dL). Delayed cord clamping also reduced the prevalence of anemia (hemoglobin level <11.0 g/dL) at 8 months in 197 (73.0%) vs 222 (82.2%) infants (relative risk, 0.89; 95% CI, 0.81-0.98; number needed to treat [NNT], 11; 95% CI, 6-54). At 8 months, the risk for iron deficiency was reduced in the delayed clamping group in 60 (22.2%) vs 103 (38.1%) patients (relative risk, 0.58; 95% CI, 0.44-0.77; NNT, 6; 95% CI, 4-13). At 12 months, delayed cord clamping still resulted in a hemoglobin level of 0.3 (95% CI, 0.04-0.5) g/dL higher than in the early cord clamping group and a relative risk for anemia of 0.91 (95% CI, 0.84-0.98), resulting in a NNT of 12 (95% CI, 7-78).Conclusions and Relevance: Delayed cord clamping reduces anemia at 8 and 12 months of age in a high-risk population, which may have major positive effects on infants' health and development.Trial Registration: clinicaltrials.gov Identifier: NCT02222805.
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| 3. |
- Rana, Nisha, 1979-, et al.
(författare)
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Delayed cord clamping was not associated with an increased risk of hyperbilirubinaemia on the day of birth or jaundice in the first 4 weeks
- 2020
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Ingår i: Acta Paediatrica. - Sweden : Wiley. - 0803-5253 .- 1651-2227. ; 109:1, s. 71-77
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Tidskriftsartikel (refereegranskat)abstract
- Aim: Our aim was to investigate the effects of timing of cord clamping on the risk of hyperbilirubinaemia.Methods: We recruited 540 normal vaginal deliveries at the Paropakar Maternity and Women’s Hospital in Kathmandu, Nepal, from October 2 to November 21, 2014. They were randomised into two groups: 257/270 were cord clamped within 60 sec‐ onds and 209/270 after 180 seconds. Transcutaneous bilirubin was measured at discharge and 24 hours. At 4 weeks, 506 mothers were successfully contacted by phone, and the health status of the baby and their history of jaundice and treatment was recorded.Results: Based on transcutaneous bilirubin at discharge, 22/261 (8.4%) in the early group and 25/263 (9.5%) in the delayed group (P = 0.76) were at high risk of subse‐ quent hyperbilirubinemia. At the 4‐week follow‐up, jaundice was reported in 13/253 (5.1%) in the early and 17/253 (6.7%) in the delayed group (P = 0.57) and 3/253 (1.2 %) of the early and 1/253 (0.4%) of the delayed group (P = 0.62) received treatment. All analyses were based on intention‐to‐treat.Conclusion: Delayed cord clamping was not associated with an increased risk of hy‐ perbilirubinaemia during the first day of life or risk of jaundice within 4 weeks com‐ pared with the early group.
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| 4. |
- Rana, Nisha, 1979-, et al.
(författare)
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Delayed cord clamping was not associated with an increased risk of hyperbilirubinaemia on the day of birth or jaundice in the first 4 weeks.
- 2020
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Ingår i: Acta paediatrica (Oslo, Norway : 1992). - Sweden : Wiley. - 1651-2227 .- 0803-5253. ; 109:1, s. 71-77
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Tidskriftsartikel (refereegranskat)abstract
- Our aim was to investigate the effects of timing of cord clamping on the risk of hyperbilirubinaemia.We recruited 540 normal vaginal deliveries at the Paropakar Maternity and Women's Hospital in Kathmandu, Nepal, from October 2 to November 21, 2014. They were randomised into two groups: 257/270 were cord clamped within 60 seconds and 209/270 after 180 seconds. Transcutaneous bilirubin was measured at discharge and 24 hours. At 4 weeks, 506 mothers were successfully contacted by phone, and the health status of the baby and their history of jaundice and treatment was recorded.Based on transcutaneous bilirubin at discharge, 22/261 (8.4%) in the early group and 25/263 (9.5%) in the delayed group (P = 0.76) were at high risk of subsequent hyperbilirubinemia. At the 4-week follow-up, jaundice was reported in 13/253 (5.1%) in the early and 17/253 (6.7%) in the delayed group (P = 0.57) and 3/253 (1.2 %) of the early and 1/253 (0.4%) of the delayed group (P = 0.62) received treatment. All analyses were based on intention-to-treat.Delayed cord clamping was not associated with an increased risk of hyperbilirubinaemia during the first day of life or risk of jaundice within 4 weeks compared with the early group.
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| 5. |
- Rana, Nisha, 1979-, et al.
(författare)
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Effect of delayed cord clamping on risk of hyperbilirubinemia in term newborns : A randomsed clinical trial in Nepal
- 2024
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Ingår i: Acta Paediatrica. - Uppsala : Acta Universitatis Upsaliensis. - 0803-5253 .- 1651-2227.
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Aim: The aim of this study is to investigate the effects of delayed cord clamping on the risk of hyperbilirubinemia in term newborns.Method: Term normal vagainal deliveries (n=540) were randomized in two groups; early (≤ 60 seconds) versus delayed (≥ 180 seconds) cord clamping between 2 October and 21 November, 2014 at Paropakar Maternity and Women's hospital in Kathmandu, Nepal. At discharge, transcutaneous bilirubin was measured on both groups. At four weeks, all parents completed a semi-structured questionnaire, health status of the baby was recorded, and jaundice was assessed and treated.Result: Based on gestational age and age measured in hours after birth, 32.3% of the early and 33.2% of the delayed group had bilirubin levels high enough for phototherapy to be considered (p=0.78). At four weeks follow up jaundice was reported among 13 (5.1%) in the early, and 17 (6.7%) in the delayed group (p=0.57). Treatment for jaundice was gven to 3 (1.2%) of the early and 1 (0.4%) of the delayed group (p=0.62).Conclution: Delayed cord clamping was not associated with an increased risk of hyperbilirubinaemia during the first day of the life or risk of jaundice within 4 weeks compared with early cord clamping group.
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