Effect of delayed versus early umbilical cord clamping on neonatal outcomes and iron status at 4 months: a randomised controlled trial

ObjectiveRevised guidelines for caesarean section (CS) advise maternal antibiotic administration prior to skin incision instead of after umbilical cord clamping, unintentionally exposing the infant to antibiotics antenatally. We aimed to investigate if timing of intrapartum antibiotics contributes to the impairment of microbiota colonisation in CS born infants.DesignIn this randomised controlled trial, women delivering via CS received antibiotics prior to skin incision (n=20) or after umbilical cord clamping (n=20). A third control group of vaginally delivering women (n=23) was included. Faecal microbiota was determined from all infants at 1, 7 and 28 days after birth and at 3 years by 16S rRNA gene sequencing and whole-metagenome shotgun sequencing.ResultsCompared with vaginally born infants, profound differences were found in microbial diversity and composition in both CS groups in the first month of life. A decreased abundance in species belonging to the genera Bacteroides and Bifidobacterium was found with a concurrent increase in members belonging to the phylum Proteobacteria. These differences could not be observed at 3 years of age. No statistically significant differences were observed in taxonomic and functional composition of the microbiome between both CS groups at any of the time points.ConclusionWe confirmed that microbiome colonisation is strongly affected by CS delivery. Our findings suggest that maternal antibiotic administration prior to CS does not result in a second hit on the compromised microbiome. Future, larger studies should confirm that antenatal antibiotic exposure in CS born infants does not aggravate colonisation impairment and impact long-term health.

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Effects of early versus delayed umbilical cord clamping during antepartum lower segment caesarean section on placental delivery and postoperative haemorrhage: a randomised controlled trial

Ceylon Medical Journal ◽

10.4038/cmj.v62i1.8425 ◽

2017 ◽

Vol 62 (1) ◽

pp. 5 ◽

Cited By ~ 3

Author(s):

M Withanathantrige ◽

I M R Goonewardene

Keyword(s):

Randomised Controlled Trial ◽

Caesarean Section ◽

Umbilical Cord ◽

Controlled Trial ◽

Lower Segment ◽

Postoperative Haemorrhage ◽

Lower Segment Caesarean Section ◽

Cord Clamping ◽

Umbilical Cord Clamping ◽

Randomised Controlled

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Effect of Delayed Versus Early Umbilical Cord Clamping on Neonatal Outcomes and Iron Status at 4 Months

Obstetric Anesthesia Digest ◽

10.1097/01.aoa.0000426112.00542.f3 ◽

2013 ◽

Vol 33 (1) ◽

pp. 49

Author(s):

O. Andersson ◽

L. Hellström-Westas ◽

D. Andersson ◽

M. Domellöf

Keyword(s):

Umbilical Cord ◽

Iron Status ◽

Neonatal Outcomes ◽

Cord Clamping ◽

Umbilical Cord Clamping

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Wait a minute? An observational cohort study comparing iron stores in healthy Swedish infants at 4 months of age after 10-, 60- and 180-second umbilical cord clamping

BMJ Open ◽

10.1136/bmjopen-2017-017215 ◽

2017 ◽

Vol 7 (12) ◽

pp. e017215 ◽

Cited By ~ 5

Author(s):

Ulrica Askelöf ◽

Ola Andersson ◽

Magnus Domellöf ◽

Anders Fasth ◽

Boubou Hallberg ◽

...

Keyword(s):

Umbilical Cord ◽

Serum Ferritin ◽

Iron Status ◽

Controlled Trial ◽

University Hospital ◽

Term Infants ◽

Ferritin Concentration ◽

Stem Cell Source ◽

Cord Clamping ◽

Randomised Controlled

Background and objectiveUmbilical cord blood (UCB) is a valuable stem cell source used for transplantation. Immediate umbilical cord (UC) clamping is widely practised, but delayed UC clamping is increasingly advocated to reduce possible infant anaemia. The aim of this study was to investigate an intermediate UC clamping time point and to evaluate iron status at the age of 4 months in infants who had the UC clamped after 60 s and compare the results with immediate and late UC clamping.DesignProspective observational study with two historical controls.SettingA university hospital in Stockholm, Sweden, and a county hospital in Halland, Sweden.MethodsIron status was assessed at 4 months in 200 prospectively recruited term infants whose UC was clamped 60 s after birth. The newborn baby was held below the uterine level for the first 30 s before placing the infant on the mother’s abdomen for additional 30 s. The results were compared with data from a previously conducted randomised controlled trial including infants subjected to UC clamping at ≤10 s (n=200) or ≥180 s (n=200) after delivery.ResultsAfter adjustment for age differences at the time of follow-up, serum ferritin concentrations were 77, 103 and 114 µg/L in the 10, 60 and 180 s groups, respectively. The adjusted ferritin concentration was significantly higher in the 60 s group compared with the 10 s group (P=0.002), while the difference between the 60 and 180 s groups was not significant (P=0.29).ConclusionIn this study of healthy term infants, 60 s UC clamping with 30 s lowering of the baby below the uterine level resulted in higher serum ferritin concentrations at 4 months compared with 10 s UC clamping. The results suggest that delaying the UC clamping for 60 s reduces the risk for iron deficiency.Trial registration numberNCT01245296.

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