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Effect of Delayed Cord Clamping on Neurodevelopment at 4 Years of Age: A Randomized Clinical Trial
Ola Andersson1, Barbro Lindquist2, Magnus Lindgren3
1Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
Insights
Delayed umbilical cord clamping (CC) improved fine-motor and social development scores in children at 4 years of age. This practice may positively impact neurodevelopment, particularly in boys, in high-income countries.
Area of Science:
- Pediatric neurodevelopment
- Neonatal care practices
- Iron deficiency prevention
Background:
- Delayed umbilical cord clamping (CC) prevents infant iron deficiency up to 6 months.
- Long-term neurodevelopmental effects of delayed CC beyond 12 months were previously unreported.
Purpose of the Study:
- To assess the neurodevelopmental outcomes at 4 years of age in children randomized to delayed CC versus early CC.
- Investigate the impact of CC timing on cognitive, motor, and behavioral development.
Main Methods:
- Follow-up of a randomized clinical trial involving 382 full-term infants.
- Neurodevelopmental assessments at 4 years included WPPSI-III, Movement ABC, ASQ, and Strengths and Difficulties Questionnaire.
- Data analyzed by intention to treat.
Main Results:
- No significant differences in overall IQ (WPPSI-III) between groups.
- Delayed CC showed improved scores in ASQ personal-social and fine-motor domains, and the Strengths and Difficulties Questionnaire prosocial subscale.
- Boys in the delayed CC group exhibited significantly higher scores in processing speed, fine-motor, and personal-social domains.
Conclusions:
- Delayed CC, compared to early CC, positively influenced fine-motor and social development at 4 years, especially in boys.
- Optimizing the timing of umbilical cord clamping may be a strategy to enhance neurodevelopment in low-risk populations.
- Findings suggest potential long-term benefits of delayed CC on child development.
Importance:
Prevention of iron deficiency in infancy may promote neurodevelopment. Delayed umbilical cord clamping (CC) prevents iron deficiency at 4 to 6 months of age, but long-term effects after 12 months of age have not been reported.
Objective:
To investigate the effects of delayed CC compared with early CC on neurodevelopment at 4 years of age.
Design, Setting, And Participants:
Follow-up of a randomized clinical trial conducted from April 16, 2008, through May 21, 2010, at a Swedish county hospital. Children who were included in the original study (n = 382) as full-term infants born after a low-risk pregnancy were invited to return for follow-up at 4 years of age. Wechsler Preschool and Primary Scale of Intelligence (WPPSI-III) and Movement Assessment Battery for Children (Movement ABC) scores (collected between April 18, 2012, and July 5, 2013) were assessed by a blinded psychologist. Between April 11, 2012, and August 13, 2013, parents recorded their child's development using the Ages and Stages Questionnaire, Third Edition (ASQ) and behavior using the Strengths and Difficulties Questionnaire. All data were analyzed by intention to treat.
Interventions:
Randomization to delayed CC (≥180 seconds after delivery) or early CC (≤10 seconds after delivery).
Main Outcomes And Measures:
The main outcome was full-scale IQ as assessed by the WPPSI-III. Secondary objectives were development as assessed by the scales from the WPPSI-III and Movement ABC, development as recorded using the ASQ, and behavior using the Strengths and Difficulties Questionnaire.
Results:
We assessed 263 children (68.8%). No differences were found in WPPSI-III scores between groups. Delayed CC improved the adjusted mean differences (AMDs) in the ASQ personal-social (AMD, 2.8; 95% CI, 0.8-4.7) and fine-motor (AMD, 2.1; 95% CI, 0.2-4.0) domains and the Strengths and Difficulties Questionnaire prosocial subscale (AMD, 0.5; 95% CI, >0.0-0.9). Fewer children in the delayed-CC group had results below the cutoff in the ASQ fine-motor domain (11.0% vs 3.7%; P = .02) and the Movement ABC bicycle-trail task (12.9% vs 3.8%; P = .02). Boys who received delayed CC had significantly higher AMDs in the WPPSI-III processing-speed quotient (AMD, 4.2; 95% CI, 0.8-7.6; P = .02), Movement ABC bicycle-trail task (AMD, 0.8; 95% CI, 0.1-1.5; P = .03), and fine-motor (AMD, 4.7; 95% CI, 1.0-8.4; P = .01) and personal-social (AMD, 4.9; 95% CI, 1.6-8.3; P = .004) domains of the ASQ.
Conclusions And Relevance:
Delayed CC compared with early CC improved scores in the fine-motor and social domains at 4 years of age, especially in boys, indicating that optimizing the time to CC may affect neurodevelopment in a low-risk population of children born in a high-income country.
Trial Registration:
clinicaltrials.gov Identifier: NCT01581489.
