16. Journal of Maternal-Fetal and Neonatal -- Term Babies With Delayed Cor

8/19/2019 16. Journal of Maternal-Fetal and Neonatal -- Term Babies With Delayed Cor

1/26wnload by: [New York University] Date: 13 November 2015, At: 12:0

The Journal of Maternal-Fetal & Neonatal Medicine

ISSN: 1476-7058 (Print) 1476-4954 (Online) Journal homepae: http:!!"""#tan$%online#&om!loi!i'm%0

arl* +er,u, $ela*e$ &or$ &lampin: %%e&t, on hematoloi& ,tatu,n term in%ant,

.tu rte.in/ N# Nihan O$emir/ e.i Sahinolu/ 2u3a ur,o*/ Naan r3il r$al a*a

"ite t#is arti"le: A$ Akt%& 'rtekin, N$ Ni#an ()demir, *eki +a#ino&l%, !%&ba %rsoy,

)an 'rbil - 'rdal .aya /2015: 'arly vers%s delayed "ord "lamin&: 'e"ts on #ematolo&i" stat%s in term inants, !#e o%rnal o

aternal6etal - Neonatal 4edi"ine, D(7: 10$310891;05o%mal7normationB>o%malodeCi>m20

or

#hi

@iew rossmark data 6

http://www.tandfonline.com/loi/ijmf20http://www.tandfonline.com/loi/ijmf20http://dx.doi.org/10.3109/14767058.2015.1105951http://dx.doi.org/10.3109/14767058.2015.1105951http://www.tandfonline.com/action/authorSubmission?journalCode=ijmf20&page=instructionshttp://www.tandfonline.com/action/authorSubmission?journalCode=ijmf20&page=instructionshttp://www.tandfonline.com/doi/mlt/10.3109/14767058.2015.1105951http://www.tandfonline.com/doi/mlt/10.3109/14767058.2015.1105951http://www.tandfonline.com/doi/mlt/10.3109/14767058.2015.1105951http://www.tandfonline.com/doi/mlt/10.3109/14767058.2015.1105951http://www.tandfonline.com/action/journalInformation?journalCode=ijmf20http://www.tandfonline.com/action/authorSubmission?journalCode=ijmf20&page=instructionshttp://dx.doi.org/10.3109/14767058.2015.1105951http://www.tandfonline.com/action/authorSubmission?journalCode=ijmf20&page=instructionshttp://www.tandfonline.com/action/authorSubmission?journalCode=ijmf20&page=instructionshttp://www.tandfonline.com/doi/mlt/10.3109/14767058.2015.1105951http://www.tandfonline.com/doi/mlt/10.3109/14767058.2015.1105951http://www.tandfonline.com/action/journalInformation?journalCode=ijmf20http://www.tandfonline.com/loi/ijmf20


2/26

Taylor &.Francis

Taylor & Francis GroupJust Accepted by The Journal of Maternal-Fetal & Neonatal Medicine

THE JOURNAL OF

MATERNAL-FETAL

& NEONATALMEDICINE

EdHorc-nvChmf Gian Carlo Di Renzo DeMauli!

Coered inInde"Medici# andMED$NE

arl* +er,u, $ela*e$ &or$ &lampin: %%e&t, on hematoloi& ,tatu, interm in%ant,

A$ Akt%& 'rtekin, N$ Ni#an ()demir, *eki +a#ino&l%, !%&ba %rsoy, Na)an'rbil, 'rdal .aya

doi: 10$310891;05e"tive: e investi&ated t#e ee"ts o delayed and early "lamin& o t#e"ord on t#e #ematolo&i" stat%s o t#e baby at birt# and at t#e end ose"ond mont#$

4et#ods: Umbili"al "ord o babies were "lamed in t#e irst 30 se"onds/ro% 1 and ; were "lamed at 80120 se"onds /ro% 2$ Eevels o#emo&lobin, #emato"rit, iron and erritin were analysed rom t#e %mbili"al"ord blood at birt# and rom t#e veno%s samles at t#e end o se"ondmont#$

Downloadedby[New

YorkUnive

rsity] at 12:07

13

November 2015

Fes%lts: Gemo&lobin, #emato"rit, iron and erritin levels o "ord bloodwere similar in bot# &ro%s$ Gowever, t#eir levels ot#er t#an erritin were #ier in ro% 2 at t#e end ose"ond mont#$ !wo babies #ad resiratory distress and twelve neonates re"eived #otot#eray in ro% 2w#ereas only ive neonates re"eived #otot#eray in ro% 1$

on"l%sion: !erm babies to w#om delayed "ord "lamin& was erormed #ad imroved #ematolo&i"alarameters at t#e end o se"ond mont#$ !#ereore, delayin& "ord "lamin& in t#ese babies may be a avoriblearoa"# in reventin& anemia$

H 2015 !aylor - 6ran"is$ !#is rovisional ID6 "orresonds to t#e arti"le as it aeared %on a""etan"e$

6%lly ormatted ID6 and %ll te=t /G!4E versions will be made available soon$D7+EA74'F: !#e ideas and oinions e=ressed in t#e >o%rnalJs Just Accepted arti"les do not ne"essarily rele"t t#ose o !aylor - 6ran"is /t#e I%blis#er, t#e 'ditors or t#e

>o%rnal$ !#e I%blis#er does not ass%me any resonsibility or any in>%ry and9or dama&e to ersons or roerty arisin& rom or related to any %se o t#e material "ontained in t#esearti"les$ !#e reader is advised to "#e"k t#e aroriate medi"al literat%re and t#e rod%"t inormation "%rrently rovided by t#e man%a"t%rer o ea"# dr%& to be administered to veriy

t#e dosa&es, t#e met#od and d%ration o administration, and "ontraindi"ations$ 7t is t#e resonsibility o t#e treatin& #ysi"ian or ot#er #ealt# "are roessional, relyin& on #is or #er indeendent e=erien"e and knowled&e o t#e atient, to determine dr%& dosa&es and t#e best treatment or t#e atient$ Just Accepted arti"les #ave %nder&one %ll s"ientii"review b%t none o t#e additional editorial rearation, s%"# as "oyeditin&, tyesettin&, and rooreadin&, as #ave arti"les %blis#ed in t#e traditional manner$ !#ere may, t#ereore,be errors in Just Accepted arti"les t#at will be "orre"ted in t#e inal rint and inal online version o t#e arti"le$ Any %se o t#e Just Accepted arti"les is s%b>e"t to t#ee=ress %nderstandin& t#at t#e aers #ave not yet &one t#ro% t#e %ll K%ality "ontrol ro"ess rior to %bli"ation$


3/26

Early verss delayed !ord !lam"in#: E$e!ts on %ematolo#i!stats in term in&ants

'('kt# Ertekin 1) *orres"ondin# at%or , Department of Health

Sciences, Uskudar University, Istanbul, Turkey

S! " #$% &'(

()**&+ a. "

#$% (+'&$/( E-

mail"

aaertekin01mail

2com

323ihan 45demir (, Department of 4bstetrics, 6eynep

7amil 8omen and Children9s Disease, Trainin1 and

:esearch Hospital, Istanbul, Turkey

S! " #$% &') +')&& E-mail "

nihanaslaner01mail2com

+eki ,a%ino#l 2) De"artment o& -erinatolo#y) *lini! o&

.bsteri!s and /yne!olo#y) 'nadol ealt% *enter) o!aeli)

rkeyS! " #$% &'( +/&/+

Email : 4eki(sa%ino#lanadolsa#lik(or#

Tu1ba ursoy ', Department of ;ediatrics, 7oc University

,!%ool o& 6edi!ine, Istanbul, Turkey

Download

edby[New

YorkUnive

rsity] at 12:07

13

November 2015

mailto:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]


4/26

S! " #$% &'' &//&$// E-mail " t1ursoy0ku2edu2tr

3a5an Erbil /, Department of ;ediatrics, 6eynep 7amil

8omen and Children9s Disease, Trainin1 and :esearch

Hospital, Istanbul, Turkey S! " #$% &'( &('%)& E-

mail " erbilna5an0hotmail2com

mailto:[email protected]:[email protected]:[email protected]:[email protected]


5/26

Erdal 7aya &, Department of 4bstetrics and ynecolo1y,

ective" 8e investi1ated the e?ects of delayed and early

clampin1 of the cord on the hematolo1ic status of the baby

at birth and at the end of second month2

Download

edby[New

YorkUnive

rsity] at 12:07

13

November 2015

8omen andChildr

7

8

9

Downloadedby[New

YorkUnive

rsity] at 12:07

13

November 2015

mailto:[email protected]:[email protected]


6/26

!ethods" Umbilical cord of */ babies =ere clamped in the

@rst '% seconds Aroup B and *+ =ere clamped at $%-(%

seconds Aroup (B2 evels of hemo1lobin, hematocrit, ironand ferritin =ere analysed from the umbilical cord blood at

birth and from the venous samples at the end of second

month2

:esults" Hemo1lobin, hematocrit, iron and ferritin levels of

cord blood =ere similar in both 1roups2 Ho=ever, theirlevels other than ferritin =ere hi1her in roup ( at the end

of second month2 T=o babies had respiratory distress and

t=elve neonates received phototherapy in roup ( =hereas

only @ve neonates received phototherapy in roup 2

Conclusion" Term babies to =hom delayed cord clampin1

=as performed had improved hematolo1ical parameters at

the end of second month2 Therefore, delayin1 cord

clampin1 in these babies may be a favorible approach in

preventin1 anemia2

7ey=ords" early and delayed cord clampin1, hemo1lobin,

hematocrit, iron, ferritin2

;resented in oral format at the (%th 3ational 3eonatalo1y

Con1ress, pril &-), (%(,


7/26

nemia is an important health problem all over the =orld,

especially in developin1 or lo= income countries amon1

ne=born infants or children and it is also associated =ith

poor neurodevelopment of the infant2 Iron in the blood is

essential for brain development, neurotransmitter function,

1lial and neuronal ener1y metabolism and myelination -

&F2 In youn1 children, iron de@ciency anemia is associated=ith behavioral and co1nitive de@cits, impaired motor

development and altered a?ective respondin1 +,*F2

;reventin1 infants and children from anemia is an

important health policy of the countries and for overcomin1

this problem there is no e.act consensus about early and

delayed cord clampin1 of the neonate or active and passive

mana1ement of the third sta1e of labor for preventin1

postpartum anemia in =omen2


8/26

increase maternal morbidity and mortality2 nother lo1ic of

the use of uterotonic dru1s is to allo= more blood

transfusion from placenta to the baby =ith the contractions

of the uterus $F2 In delayed cord clampin1, appro.imately

)%-%% ml of blood can be transferred to the baby =hich

contributes (%-'% m1Gk1 of iron %,F2 In preterm

neonates, delayed cord clampin1 has also secondaryfavorable outcomes such as reduction in the incidence of

transfusion, respiratory support, intraventricular hemorrha1e

and sepsis (,'F2 There may be some adverse e?ects

=ith delayed cord clampin1, =hich are hyperbilirubinemia,

increased need for phototherapy, polycythemia and

respiratory symptoms/-*F2

Download

edby[New

YorkUnive

rsity] at 12:07

13

Novem

ber 2015


9/26

6et%ods

This prospective case-control study =as conducted in

6eynep 7amil !aternity and Children9s Disease, Trainin1

and :esearch Hospital, bet=een u1ust , (% and

3ovember '%, (%2 The study =as approved by the local

Ethics Committee2 The inclusin1 criteria =ere as follo=s

neonates born to sin1le and term pre1nancies A'* to / #+=eeksB, non-smokin1 and healthy mothers2 The e.clusion

criteria =ere preterm and multiple pre1nancies, operative

deliveries, neonates necessitatin1 recussitation, presence of

fetal anomalies, intrauterine 1ro=th restriction, maternal

diseases or dru1 use, placental anomalies and reuest for

cord blood bankin12

The primary outcome =as to investi1ate the e?ect of early

and delayed clampin1 of the umbilical cord on the

hematolo1ic status of the neonate at birth and at the end of

second month2 The secondary outcomes =ere to analyse

e?ect of delayed clampin1 on the incidence of maternal

blood loss, neonatal respiratory distress, hyperbilirubinemia,

phototherapy need, neonatal intensive care unit A3ICUB

admission and len1th of hospitalisation2

Informed consent =as obtained from the mothers =ho met

the inclusion criteria and =illin1 to participate in the study2

Downloadedby[New

YorkUniversity] at 12:07

13

November 2015


10/26

!other and infant pairs =ere divided in ( 1roups, early

Aroup B and delayed Aroup (B cord clampin12 In roup

cord =as clamped in the @rst '% seconds and in roup (

cord =as clamped $% to (% seconds after delivery2

Delivery of the infant shoulder =as accepted as the 5ero

time and a sta? in all births recorded the clampin1 time

=ith a stop-=atch2 In cesarean and va1inal births, babies=ere put on a ne=born table in =hich the level of the baby

and uterus =as similiar in both 1roups and then the cord

=as clamped early or delayed2 fter clampin1 the umbilical

cord, venous blood =as obtained from the double clamped

umbilical cord of both 1roups for hemo1lobin, hematocrit,

iron and


11/26

ferritin analyses and no blood was wit%drawn &rom t%e

"eri"%eral vein be!ase o& t%e stdy desi#n ma;or

!omment 2


12/26

?eslts

The demo1raphic characteristics of the mother-infant pairs

and hematolo1ical parameters of the mothers did not di?erbet=een the 1roups ATable B2 Ho=ever, delivery by

cesareanne section =as si1ni@cantly hi1her in roup 2 =n

/ro" 1 and /ro" 2 avera#e !ord !lam"in# times were

20)5 and 101)1 se!onds) res"e!tively ma;or !omment 1


13/26

2 ml &or dire!t and indire!t bilirbin) blood ty"e and

dire!t !oombs test ma;or !omment 5


14/26

Dis!s

sion8orld Health 4r1anisation advises late cord clampin1

ho=ever there is a debate on the optimal time for cord

clampin1 )F2 If the cord clampin1 is deferred more than

+% seconds, blood Mo= bet=een the baby and placenta

continues and is usually completed by (% seconds and

named as placental transfusion2 This allo=s the transfusionof )%-%% ml of blood =hich constitutes about one third or

a uarter of the ne=borns total blood volume %F2 Even

thou1h not fully clear, placental transfusion could be

considered as a cause of some undesirable e?ects in the

ne=born and as =ell as in the mother such as polycytemia,

>aundice, respiratory symptoms, phototherapy need and

postpartum uterine hemorrha1e2 In this study, althou1h the

incidence of >aundice necessitatin1 phototherapy =as hi1her

in infants =hose cords =ere clamped late, this di?erence

did not reach statistical si1ni@cance A+,)L vs &,*L

pN%,%)B as con@rmed in the literature $-((F2 s

mentioned in the material- methods, =e paid attention to

put all the neonates on a ne=born table =hich =as

appro.imately at the same level =ith the uterus to facilitate

blood transmission from the placenta to the ne=born2

Ho=ever, in a multicenter trial at three university-aOliated


15/26

Dis!s

sionhospitals in r1entina, the autors mentioned that position of

the ne=born baby before cord clampin1 does not seem to

a?ect volume of placental transfusion2 Therefore, mothers

could safely be allo=ed to hold their baby on their

abdomen or chest2 This chan1e in practice mi1ht increase

obstetric compliance =ith the procedure, enhance maternal-infant bondin1 and decrease iron de@ciency in infancy ('F2

8e found that delayin1 cord clampin1 up to $% to (%

seconds increases hemo1lobin, hematocrit and iron levels

si1ni@cantly at the second month2 lthou1h there =as no

di?erence of iron levels bet=een early and delayed cordclampin1 1roups at birth, a si1ni@cantly hi1her iron level

=as achieved at the second month of a1e in the delayed

clamped 1roup2 n increase of serum iron level rather than

hemo1lobin, allo=s more tissue

Download

edby[New

YorkUnive

rsity] at 12:07

13

November 2015


16/26

o.y1enation, proper myelini5ation, improved hematolo1ic

parameters and less ventilator support (/,(&F2 Iron is an

essential trophic factor that is reuired for o.y1enconsumption and T; production2 The brain has a

relatively hi1h rate of o.y1en consumption compared to

other or1ans2 4li1odendrocytes are the principal cells in the

central nervous system that stain for iron under normal

conditions2 The timin1 of iron delivery to oli1odendrocytes

durin1 myelini5ation is essential because hypomyelination

and the associated neurolo1ical seuelae persist lon1 after

the systemic iron de@ciency has been corrected2 Due to the

hypomyelination, most common neurolo1ical si1ns of iron

de@ciency in children include poor school performance,

decreased co1nitive abilities and behavior problems (+F2

urthermore, these neurolo1ical seuelae persist even after

iron supplementation2

8hile prominent positive e?ects of delayed cord clampin1

on hemo1lobin, hematocrit and serum iron levels =ere =ell

established, clampin1 cord after the @rst breath of theneonate =as sho=n to have improvin1 e?ect on neonatal

cardiac and pulmonary functions $F2 In a study includin1

of &2&+' ne=borns outcomes in a rural hospital, the risk

of deathG3ICU admission =as consistently hi1her if cord

clampin1 occurred before spontaneous respiration (*F2

Download

edby[New

YorkUnive

rsity] at 12:07

13

November 2015


17/26

8hile infants of birth =ei1ht P(&%% 1 =ere more likely to

die or be admitted at 3ICU, the risk of death or 3ICU

admission decreased by (%L for every %-second delay incord clampin1 after spontaneous respiration2 The authors

concluded that healthy self-breathin1 neonates =ere more

likely to die or be admitted if cord clampin1 occured

before or immediately after onset of spontaneous

respiration2 These clinical observations support the

e.perimental @ndin1s of an animal based study

demonstratin1 smoother cardiovascular transition =ith

delayed cord clampin1 after initiation of ventilation $F2

It =as kno=n that umbilical cord blood contains various

valuable stem cells such as haematopoietic stem cells,

endothelial cell precursors, mesenchymal pro1enitors and

multipotentGpluripotent linea1e stem cells2


18/26

delayed cord clampin1, the merit of delayed cord clampin1

has been ma1ni@ed by reali5in1 @rst stem cell transfer2 In

vie= of this purpose, not only in preterm births, delayedcord clampin1 should be encoura1ed in term births too

()F2

8e conclude that delayed cord clampin1 in term babies

had no e?ect on hematolo1ic status at birth but had

improvin1 e?ects on hemo1lobin, hematocrit and iron levelsat the second month =ithout any serious complication2

Ho=ever, phototherapy need may be increased in delayed

1roup2

Delayed cord clampin1 could be considered an appropriate

and easy to perform approach in increasin1 iron levels,

circulatin1 blood volume and stem cells =hich seem to be

key factors in myelini5ation and smooth passa1e to

e.trauterine circulation in term neonates2 on1 term follo=

up studies should be performed to evaluate the e?ects of

hi1her iron levels on the neuroco1nitive outcome of the

babies2

'!knowled#ements

The authors report no ackno=led1ements2

De!laration o& interest

The authors report no declarations of interest

Download

edby[New

YorkUnive

rsity] at 12:07

13

November 2015


19/26

?e&eren!es

2 o5o?


20/26

*2 unnarsson


21/26

$2 Dley G) Katey N( ."timal timin# o& mbili!al !ord

!lam"in# &or term and "reterm babies( Early man

Develo"ment 2013LBH:H05H0B(%2 @arrar D) 'irey ?) Gaw /) $nell D) *attle K)

Dley G( 6easrin# "la!ental trans&sion &or term birt%s:

wei#%in# babies wit% !ord inta!t( K./ 2011L11B:705(

2 6!Donald ,) 6iddleton -) Dowswell ) 6orris -,(

E$e!t o& timin# o& mbili!al !ord !lam"in# o& term in&ants

on maternal and neonatal ot!omes( *o!%rane Database

,yst ?ev 2013L7: *D00I07I(

(2 6er!er ) Mo%r K) 6!/rat% 6) -adbry ) alla!%

6) .% ( Delayed !ord !lam"in# in very "reterm in&ants

red!es t%e in!iden!e o& intraventri!lar %emorr%a#e and

late onset se"sis: a randomi4ed) !ontrolled trial( -ediatri!s

200AL117:1235I2(

'2 .% ) @anaro$ ') *arlo ) Donovan E) 6!Donald

,) -oole ( E$e!ts o& delayed !ord !lam"in# in verylow

birt%wei#%t in&ants( -erinatol 2011L31:,AB71(

/2 Yao '*) Gind ) Morenkoski M( E>"iratory #rntin#in t%e late !lam"ed normal neonate( -ediatri!s

1H71LIB:BA570(

&2 ,ai#al ,) Us%er ?( ,ym"tomati! neonatal "let%ora(

Kiol Neonate 1H77L32:A272(

Download

edby[New

YorkUnive

rsity] at 12:07

13

November 2015


22/26

+2 Man ?%eenen -) Krabin K( Gate mbili!al !ord

!lam"in# as an intervention &or red!in# iron deJ!ien!y

anaemia in term in&ants in develo"in# and indstrialised!ontries: ' systemati! review( 'nn ro" -aediatr

200IL2I:31A(

*2 an# *G) 'nderson *) Geone ') ?i!% )

/ovindaswami K) @iner NN( ?ess!itation o& "reterm

neonates by sin# room air or 100C o>y#en( -ediatri!s

200BL121:10B3H(

)2 orld ealt% .r#ani4ation( *are in normal birt%: '

"ra!ti!al #ide( ,wit4erland: . ,a&e 6ot%er%ood

e!%ni!al orkin# /ro": /eneva 1HHAL"( 323(

$2 .>&ord 6idwives ?esear!% /ro"( ' stdy o& t%e

relations%i" between t%e delivery to !ord !lam"in# interval

and t%e time o& !ord se"aration( 6idwi&ery 1HH1L7: 1A7

7A(


23/26

(%2 Emhamed !4, van :heenen ;,

ita H, Hosono , !inato!, 4kada T, Takahashi S, Harada 72 Umbilical cord

milkin1 reduces the need for red cell transfusions and

improves neonatal adaptation in infants born at less than ($

=eeks9 1estation" a randomi5ed control trial2 rch Dis Child

etal 3eonatal Ed (%%)$'"/-$2

Download

edby[New

YorkUnive

rsity] at 12:07

13

November 2015


24/26

(&2 7rue1er !S, Eyal , ;eevy 7Q, Hamm C:,

8hitehurst :!, e=is D2 Delayed cord clampin1 =ith and

=ithout cord strippin1" prospective randomi5ed trial ofpreterm neonates2 m Q 4bstet ynecol (%& (("'$/ e-

'$/e&2

(+2 4ski , Honi1 S, Helu


25/26

ables

Table I2 The demo1raphic characteristics and hematolo1icalparameters in both 1roups2

D o w n l o a d e d b y [ N e w

Y o r k U n

i v e r s i t y ] a t 1 2 : 0 7

1 3

N o

v e m b e r 2 0 1 5

roup n"

*/

roup ( n"*+p

1e Amean SDB (+,&&,( (+,$&,/ %,++

ravida ( A-'B ( A-'B %,

*ord !lam"in# 20)5OA 101)1OB)3 P0)001

se!onds) mean

!aternal Hb, 1Gdl ',,* ,+,/ %,/)

Amean SDB

!aternal Hct, L '/,*' '/,+/ %,)+

SDB

6a>imm 17(A 1(B 17(H 2(1 0(7level #FdG) mean

,D<

Delivery route, * A$&,$B &' A+$,*B P%,%%

birth, n ALB


26/26

Table II2 Hematolo1ical parameters of cord blood and at the

a1e of ( months of the infants in both 1roups2

Cord blood levels Second month blood

levels

n1Gml Amean SDBpP %2%&" statistically si1ni@cant

Download

edby[New

YorkUnive

rsity] at 12:07

13

November 2015

roup roup ( p

p

Hb, &,/ &,(,) %,& $,$%,$ %,'%,

Amean

SDB

Hct, /&,*/ /+,+ %,+ ($(,( '%,'(,

Amean

SDB

e, +,( /+&% %,% +),&(&,' *$,+(&

Amean

SDB

erriti (((( *,$ %,% (/%,'/ (',

%,%%'

0)00B

0)00

1

%,+)

16. Journal of Maternal-Fetal and Neonatal -- Term Babies With Delayed Cor

Documents

Transcript of 16. Journal of Maternal-Fetal and Neonatal -- Term Babies With Delayed Cor