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Delayed umbilical cord clamping reduces anemia in high-risk infants

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January 17, 2017

Delaying umbilical cord clamping for 180 seconds in high-risk infants effectively reduced anemia by 8 and 12 months of age with minimal side effects, according to results of a randomized clinical trial.

“A delay of umbilical cord clamping for more than 3 minutes improves infants’ iron stores in general, can protect against anemia in communities where iron deficiency anemia is common, and has earlier been shown to have favorable effects on developmental outcomes at 4 years of age, even in a well-nourished population,” Ola Andersson, MD, PhD, of the department of women’s and children’s health at Uppsala University in Sweden, told HemOnc Today.

Anemia affects over 40% of all children aged 5 years or younger worldwide and is associated with long-term stunt growth and development. Iron deficiency is linked to anemia and is responsible for anemia in approximately 50% of children.

Ola Andersson
Ola Andersson

Previous research has shown clamping of the umbilical cord for 3 minutes in infants prevents iron deficiency for up to 6 months, but it has not been shown to prevent iron deficiency or anemia in older infants, Andersson said. Approximately one-third of a child’s blood is in the placenta at birth, he added. If clamping of the umbilical cord is performed immediately, the blood will remain in the placenta and go to waste. However, if clamping is postponed for 3 minutes, most of the blood — which contains hemoglobin, highly rich in iron — can flow back to the child as an extra blood transfusion.

To test this, researchers randomly assigned 540 children (boys, n = 281; mean gestational age, 39.2 weeks), born at a large obstetrical hospital in Kathmandu, Nepal — where anemia affects up to 70% of infants — to early cord clamping (less than 60 seconds; n = 270) or delayed cord clamping (longer than 180 seconds; n = 270).

Researchers conducted follow-up with infants at 8 and 12 months of age, during which they took blood samples to evaluate anemia (hemoglobin) and iron deficiency (ferritin). At 8 months, 212 infants from the delayed clamping group and 188 from the early clamping group returned for blood sampling.

At 8 months of age, infants who underwent delayed clamping generally had greater hemoglobin levels compared with the early clamping group (10.4 g/dL vs. 10.2 g/dL; difference, 0.2 g/dL; 95% CI, 0.1-0.4).

The prevalence of anemia was lower in the delayed clamping group compared with the early clamping group (n = 197 vs. 222; RR = 0.89; 95% CI, 0.81-0.98).

Further, the percentage of children who had iron deficiency at 8 months of age decreased by more than 40% in the delayed clamping group (60 vs. 103; RR = 0.58; 95% CI, 0.44-0.77).

At 12 months, hemoglobin levels remained 0.3 g/dL (95% CI, 0.04-0.5) higher in the delayed clamping group, and the reduced risk for anemia persisted in the delayed clamping group (RR = 0.91; 95% CI, 0.84-0.98).

These data equated to a number needed to treat of 12 (95% CI, 7-78).

“If the intervention was implemented on a global scale, this could translate to 5 million fewer infants with anemia at 8 months of age, with particular public health significance in South Asia and sub-Saharan Africa, where the prevalence of anemia is the highest,” the researchers wrote. – by Melinda Stevens

For more information:

Ola Andersson, MD, PhD, can be reached at International Maternal and Child Health, Department of Women’s and Children’s Health, Uppsala University, SE-751 85 Uppsala, Sweden; email:

Disclosures: The researchers report no relevant financial disclosures.

Photo credit: Martina Thalwitzer