Effect of Placental Transfusion on Iron Stores in Moderately Preterm Neonates of 30–33 weeks Gestation
- 182 Downloads
To assess the effect of placental transfusion by delayed cord clamping (DCC) of 60 s or cord milking (CM) on serum ferritin levels at hospital discharge and 3 mo of postmenstrual age (PMA) in preterm neonates of 30 to 33 wk gestation in comparison to early cord clamping (ECC) within 10 s.
This mixed longitudinal study was conducted in moderately preterm neonates of 30 to 33 wk gestation born in a level III unit in Northern India with the study sample nested within a randomized controlled trial on placental transfusion. Intervention was delayed cord clamping for 60 s or cord milking compared with early cord clamping (within 10 s). Primary outcome measure was serum ferritin levels at discharge. Secondary outcome measures were serum ferritin levels at 3 mo PMA, incidence of anemia, need for blood transfusion and incidence of iron deficiency by 3 mo PMA.
Out of the 215 randomly chosen infants, serum ferritin levels were estimated at least at one time point (at discharge or at 3 mo PMA) in 197 neonates [placental transfusion – 107; early cord clamping – 90]. Amongst them, ferritin level was estimated at discharge in 141 neonates, at 3 mo PMA in 76 neonates and at both time points in 20 neonates. Median (IQR) serum ferritin (μg/L) at discharge was significantly higher in placental transfusion group in comparison to the ECC group [399 (309,600) (n = 79) vs. 254 (190,311) (n = 62); p < 0.001]. Median (IQR) ferritin level at 3 mo PMA was not different between the study groups [20 (14,57) (n = 39) vs. 24 (8,52) (n = 37); p = 0.2]. The incidence of anemia by 3 mo PMA was significantly lesser in the placental transfusion group. No difference was observed in anemia requiring blood transfusion and iron deficiency by 3 mo PMA between the groups.
In 30 to 33 wk preterm neonates, placental transfusion resulted in significantly higher serum ferritin at discharge in comparison to early cord clamping. However, this benefit did not persist till 3 mo PMA.
KeywordsPlacental transfusion Delayed cord clamping Early cord clamping Cord milking Ferritin Iron deficiency Moderately preterm Neonate
Delayed cord clamping
Early cord clamping
Enzyme linked immunosorbent assay
BD: Collected the data, conducted the study, analyzed the data and drafted the initial manuscript; VS: Conceptualized and designed the trial, designed the data collection tool, supervised conduct of the trial, analyzed the data and critically reviewed the manuscript and approved the final manuscript; PK: Conceptualized and designed the trial and the data collection tool, supervised conduct of the trial, critically reviewed and approved the final manuscript; WTM: Conceptualized the study, critically reviewed and approved the final manuscript; LKD: Significantly contributed in the trial design, supervised the conduct of the trial, critically reviewed and approved the final manuscript; RD: Performed measurement of ferritin values, assisted in data analysis, critically reviewed and approved the final manuscript. PK will act as guarantor for this paper.
Compliance with Ethical Standards
Conflict of Interest
Source of Funding
- 1.International Institute for Population Sciences (IIPS) and Macro International. National Family Health Survey (NFHS-3), 2005–06: India: Volume I. Mumbai: IIPS; 2007.Google Scholar
- 6.World Health Organization. Iron deficiency anaemia: assessment, prevention and control: a guide for programme managers. Available at: http://www.who.int/nutrition/publications/en/ida_assessment_prevention_control.pdf. Accessed on 3 Feb, 2015.
- 10.McDonald SJ, Middleton P, Dowswell T, Morris PS. Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. Cochrane Database Syst Rev. 2013;7:CD004074.Google Scholar
- 15.Perlman JM, Wyllie J, Kattwinkel J, et al; Neonatal Resuscitation Chapter Collaborators. Part 11: Neonatal resuscitation: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Circulation. 2010;122:S516–38.Google Scholar
- 16.Lubin BH. Reference values in infancy and childhood. In: Nathan DG, Oski FA, editors. Hematology of infancy and childhood. 2nd ed. Philadelphia: WB Saunders Co; 1981. p. 1552–74.Google Scholar
- 19.WHO Multicentre Growth Reference Study Group. WHO child growth standards based on length/height, weight and age. Acta Paediatr Suppl. 2006;450:76–85.Google Scholar