BMJ 2015;350:h2828 doi: 10.1136/bmj.h2828 (Published 27 May 2015)
Page 1 of 1
Research News
RESEARCH NEWS Delaying cord clamping is linked to improvements in fine motor skills Jacqui Wise London
Delaying clamping the umbilical cord for around three minutes is associated with better fine motor function and social skills in children at the age of 4 years, a randomised controlled trial has found.1
Delaying umbilical cord clamping by two to three minutes after delivery allows fetal blood remaining in the placental circulation to be transfused back into the newborn baby. It has previously been shown to produce higher haemoglobin concentrations after birth and increased iron stores until 6 months of age. However, there has been little evidence on the effects of delaying clamping on long term neurodevelopmental outcomes. Many clinicians have incorporated delayed cord clamping into practice, but there has been a hesitation to endorse the practice in guidelines, particularly with full term infants, because of a lack of evidence on long term safety and benefits.
The authors said that their study population was a group of low risk children born in a high income country with a low prevalence of iron deficiency. “Still, differences between the groups were found, indicating that there are positive, and in no instance harmful, effects from delayed cord clamping,” they concluded.
In an accompanying editorial Heike Rabe, from Brighton and Sussex Medical School, and colleagues wrote, “Their important findings suggest that there is an absence of harm that lasts until 4 years of age.” They added, “The potential benefit of improving maternal and neonatal care by a simple no-cost intervention of delayed cord clamping should be championed by the international community beginning now and leading into the next decade.”2
The new study in JAMA Pediatrics involved 382 full term infants born after a low risk pregnancy at a Swedish hospital who were invited to return for assessment with a psychologist at 4 years of age. Two thirds of the children returned for follow-up, of whom 141 had delayed clamping of three or more minutes, and 122 had had the cord clamped within 10 seconds of delivery.
The study found no difference between the two groups in full scale IQ or behavioural difficulties. However, children in the delayed cord clamping group showed improvements in the personal-social scale (adjusted mean difference 2.8 (95% confidence interval 0.8 to 4.7)) and in fine motor skills (adjusted mean difference 2.1 (0.2 to 4.0)). Boys, who are generally more prone to iron deficiency, were shown to have the biggest differences, particularly in fine motor skills. The study did have limitations, as a third of the original study group did not return for follow-up, although no major differences in baseline data were seen between children who returned and those who did not.
For personal use only: See rights and reprints http://www.bmj.com/permissions
1 2
Andersson O, Lindquist B, Lindgren M, et al. Effect of delayed cord clamping on neurodevelopment at 4 years of age: a randomized clinical trial. JAMA Pediatrics 26 May 2015, doi:10.1001/jamapediatrics.2015.0358. Rabe H, Erickson-Owens D, Mercer J. Long term follow up of placental transfusion in full-term infants. JAMA Pediatrics 26 May 2015, doi:10.1001/jamapediatrics.2015.0431.
Cite this as: BMJ 2015;350:h2828 © BMJ Publishing Group Ltd 2015
Subscribe: http://www.bmj.com/subscribe
Page 1 of 1
Research News
RESEARCH NEWS Delaying cord clamping is linked to improvements in fine motor skills Jacqui Wise London
Delaying clamping the umbilical cord for around three minutes is associated with better fine motor function and social skills in children at the age of 4 years, a randomised controlled trial has found.1
Delaying umbilical cord clamping by two to three minutes after delivery allows fetal blood remaining in the placental circulation to be transfused back into the newborn baby. It has previously been shown to produce higher haemoglobin concentrations after birth and increased iron stores until 6 months of age. However, there has been little evidence on the effects of delaying clamping on long term neurodevelopmental outcomes. Many clinicians have incorporated delayed cord clamping into practice, but there has been a hesitation to endorse the practice in guidelines, particularly with full term infants, because of a lack of evidence on long term safety and benefits.
The authors said that their study population was a group of low risk children born in a high income country with a low prevalence of iron deficiency. “Still, differences between the groups were found, indicating that there are positive, and in no instance harmful, effects from delayed cord clamping,” they concluded.
In an accompanying editorial Heike Rabe, from Brighton and Sussex Medical School, and colleagues wrote, “Their important findings suggest that there is an absence of harm that lasts until 4 years of age.” They added, “The potential benefit of improving maternal and neonatal care by a simple no-cost intervention of delayed cord clamping should be championed by the international community beginning now and leading into the next decade.”2
The new study in JAMA Pediatrics involved 382 full term infants born after a low risk pregnancy at a Swedish hospital who were invited to return for assessment with a psychologist at 4 years of age. Two thirds of the children returned for follow-up, of whom 141 had delayed clamping of three or more minutes, and 122 had had the cord clamped within 10 seconds of delivery.
The study found no difference between the two groups in full scale IQ or behavioural difficulties. However, children in the delayed cord clamping group showed improvements in the personal-social scale (adjusted mean difference 2.8 (95% confidence interval 0.8 to 4.7)) and in fine motor skills (adjusted mean difference 2.1 (0.2 to 4.0)). Boys, who are generally more prone to iron deficiency, were shown to have the biggest differences, particularly in fine motor skills. The study did have limitations, as a third of the original study group did not return for follow-up, although no major differences in baseline data were seen between children who returned and those who did not.
For personal use only: See rights and reprints http://www.bmj.com/permissions
1 2
Andersson O, Lindquist B, Lindgren M, et al. Effect of delayed cord clamping on neurodevelopment at 4 years of age: a randomized clinical trial. JAMA Pediatrics 26 May 2015, doi:10.1001/jamapediatrics.2015.0358. Rabe H, Erickson-Owens D, Mercer J. Long term follow up of placental transfusion in full-term infants. JAMA Pediatrics 26 May 2015, doi:10.1001/jamapediatrics.2015.0431.
Cite this as: BMJ 2015;350:h2828 © BMJ Publishing Group Ltd 2015
Subscribe: http://www.bmj.com/subscribe
