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Effect of Delayed Cord Clamping on Neurodevelopment at 3 Years: A Randomized Controlled Trial
Johan Henrik Martin Berg1,2, Manuela Isacson1,3, Omkar Basnet4
1Department of Clinical Sciences Lund, Pediatrics, Lund University, Lund, Sweden.
Insights
Delayed umbilical cord clamping (CC) showed no overall neurodevelopmental differences at age 3. However, delayed CC may benefit gross motor development in girls, warranting further research into long-term iron deficiency impacts.
Area of Science:
- Neonatal care and developmental pediatrics.
Background:
- Iron deficiency (ID) is linked to impaired neurodevelopment.
- Previous research indicated delayed umbilical cord clamping (CC) improves infant iron stores and neurodevelopment at 1 year.
Purpose of the Study:
- To evaluate the impact of delayed CC (≥180 seconds) versus early CC (≤60 seconds) on neurodevelopment at 3 years of age.
Main Methods:
- A randomized controlled trial involving 540 healthy term infants in Nepal.
- Neurodevelopmental assessment at 3 years using the Ages and Stages Questionnaire (ASQ) via parent phone interviews.
- Children scoring over 1 standard deviation below the mean were considered 'at risk' for developmental impairment.
Main Results:
- No significant differences in ASQ scores across any developmental domains were observed between the early and delayed CC groups at 3 years.
- A subgroup analysis revealed fewer girls in the delayed CC group were identified as 'at risk' for delayed gross motor development (6.3% vs. 18.9%, p=0.02).
Conclusions:
- Delayed CC did not demonstrate significant differences in overall neurodevelopmental outcomes at age 3.
- A potential benefit for gross motor development in girls with delayed CC was noted, suggesting further investigation into long-term neurodevelopmental effects is warranted.
Introduction:
Iron deficiency (ID) is associated with poor neurodevelopment. We have previously shown that delayed umbilical cord clamping (CC) improves iron stores at 8 months and neurodevelopment at 1 year in term, healthy infants in Nepal.
Objective:
The aim of this study was to assess the effects of delayed CC (≥180 s) compared to early CC (≤60 s) on neurodevelopment using the Ages and Stages Questionnaire (ASQ) at age 3 years.
Methods:
In 2014, 540 healthy Nepalese infants born at term were randomized in a 1:1 ratio to delayed or early CC. At 3 years of age, ASQ assessment was performed by phone interviews with parents. A score >1 standard deviation below the mean was defined as "at risk" for developmental impairment.
Results:
At 3 years of age, 350 children were followed up, 170 (63.0%) in the early CC group and 180 (66.7%) in the delayed CC group. No significant differences in ASQ scores in any domains between groups were found. However, more girls were "at risk" for affected gross motor development in the early CC group: 14 (18.9%) versus 6 (6.3%), p = 0.02.
Conclusion:
There were no significant differences in ASQ scores in any domains between groups. In the subgroup analysis, fewer girls who underwent delayed CC were "at risk" for delayed gross motor development. Due to the pronounced difference in iron stores at 8 months postpartum in this cohort, follow-up studies at an older age are motivated since neurodevelopmental impairment after early ID may be more detectable with increasing age.
