Delayed umbilical cord clamping to help prevent iron deficiency in infancy was associated with improved scores in fine-motor and social skills in children at age 4, particularly in boys, compared with children whose cords were clamped seconds after delivery, according to a recent study.

OT_News-01The research did not show an association between delayed clamping and any effect on overall IQ or behavior compared with cord clamping right after delivery. Findings were published May 26 on the website of JAMA Pediatrics.

Iron deficiency is a global health issue among preschool children that can lead to impaired neurodevelopment and can affect cognitive, motor and behavioral abilities, according to the World Health Organization. Delaying umbilical cord clamping by two to three minutes after delivery allows fetal blood remaining in the placental circulation to be transfused back to the newborn. Past research has shown this process is associated with improved iron status at 4-6 months of age. WHO guidelines recommend delaying cord clamping for at least one minute.

A lack of knowledge exists regarding the long-term effects and evidence of no harm, causing policymakers to be hesitant about making clear recommendations concerning delayed cord clamping in full-term infants, the authors wrote in the study background.

The study

Ola Andersson, MD, PhD, of Uppsala University, Sweden, and co-authors conducted a follow-up of a randomized clinical trial at a Swedish hospital to assess the long-term effects of delayed cord clamping on neurodevelopment in children at age 4. The authors evaluated 263 children (about 69% of the original study population) based on IQ tests and assessments and questionnaires measuring development and behavior. Delayed cord clamping (141 children in follow-up) was defined as more than or equal to three minutes after delivery and early cord clamping (122 children in follow-up) was less than or equal to 10 seconds after delivery.

The authors found no difference between the two groups for full-scale IQ, according to the study results. However, the proportion of children with an immature pencil grip was lower in the delayed cord clamping group compared with the early cord clamping group (13.2% vs. 25.6%), the findings showed. The delayed clamping group also had higher scores in personal-social and fine-motor skill assessments, according to the results.

There were no differences between the groups for girls in any of the assessments. However, the results showed boys who had delayed cord clamping had higher average scores in several tasks involving fine-motor function and personal-social domains.

“Delaying [cord clamping] for three minutes after delivery resulted in similar overall neurodevelopment and behavior among 4-year-old children compared with early CC,” the authors wrote. “However, we did find higher scores for parent-reported prosocial behavior as well as personal-social and fine-motor development at 4 years, particularly in boys.”

The researchers note the children in the study are “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 CC,” they wrote. “Future research should involve large groups to secure enough power to draw clear conclusions regarding development.”

In a related editorial, Heike Rabe, MD, PhD, of the Brighton and Sussex Medical School and University Hospitals, Brighton, England, and co-authors wrote that the study helps fill in an evidence gap about the long-term safety of delayed cord clamping in healthy, full-term infants.

“Until now, data on long-term follow-up of preterm and full-term infants who have been randomized to early vs. delayed CC have been limited,” Rabe and co-authors wrote. “Awareness of the benefits for all newborns continues to increase as more studies are published.”

Findings from the study suggest an absence of harm from delayed cord clamping that lasts until infants are 4 years old, according to the editorial authors.

“While many physicians have incorporated delayed CC into practice, there remains a hesitation to implement delayed CC, particularly with full-term infants,” they wrote. “As evidence of the safety and benefits of delayed CC are demonstrated, this hesitation should disappear.”

Study abstract: http://archpedi.jamanetwork.com/article.aspx?doi=10.1001/jamapediatrics.2015.0358

Editorial: http://archpedi.jamanetwork.com/article.aspx?doi=10.1001/jamapediatrics.2015.0431