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Am J Perinatol 2022; 39(01): 037-044
DOI: 10.1055/s-0040-1714258
Original Article

The Effects of Delayed Cord Clamping on 12-Month Brain Myelin Content and Neurodevelopment: A Randomized Controlled Trial

Judith S. Mercer
1   College of Nursing, University of Rhode Island, Kingston, Rhode Island
2   Department of Pediatrics, Women and Infants Hospital of Rhode Island, Providence, Rhode Island
3   Pediatrics, Alpert School of Medicine, Brown University, Providence, Rhode Island
,
Debra A. Erickson-Owens
1   College of Nursing, University of Rhode Island, Kingston, Rhode Island
2   Department of Pediatrics, Women and Infants Hospital of Rhode Island, Providence, Rhode Island
,
Sean C.L. Deoni
4   Advanced Baby Imaging Lab, Memorial Hospital of Rhode Island, Pawtucket, Rhode Island
5   Maternal, Neonatal, and Child Health, Discovery and Tools, Bill and Melinda Gates Foundation, Munirka, New Delhi, India
,
Douglas C. Dean III
6   Department of Pediatrics, University of Wisconsin, Madison, Wisconsin
7   Department of Medical Physics, University of Wisconsin, Madison, Wisconsin
8   Waisman Laboratory for Brain Imaging and Behavior, Waisman Center, University of Wisconsin, Madison, Wisconsin
,
Richard Tucker
2   Department of Pediatrics, Women and Infants Hospital of Rhode Island, Providence, Rhode Island
,
Ashley B. Parker
2   Department of Pediatrics, Women and Infants Hospital of Rhode Island, Providence, Rhode Island
,
Sarah Joelson
4   Advanced Baby Imaging Lab, Memorial Hospital of Rhode Island, Pawtucket, Rhode Island
,
Emily N. Mercer
4   Advanced Baby Imaging Lab, Memorial Hospital of Rhode Island, Pawtucket, Rhode Island
,
Jennifer Collins
2   Department of Pediatrics, Women and Infants Hospital of Rhode Island, Providence, Rhode Island
,
James F. Padbury
2   Department of Pediatrics, Women and Infants Hospital of Rhode Island, Providence, Rhode Island
3   Pediatrics, Alpert School of Medicine, Brown University, Providence, Rhode Island
› Author Affiliations Funding This study was supported by the Bill & Melinda Gates Foundation, Seattle, WA (OPP1061070 [to J.S.M.]); the National Institutes of Health (1R01HD076589 [to J.S.M., D.A.E.-O., S.C.L.D.], R01 MH087510 [to S.C.L.D.], and R00MH110596 [to D.C.D.]). The study sponsors had no role in design, data collection, analyses, interpretation, writing of the manuscript, or decision to submit.
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Abstract

Objective This study aimed to determine if delayed cord clamping (DCC) affected brain myelin water volume fraction (VFm) and neurodevelopment in term infants.

Study Design This was a single-blinded randomized controlled trial of healthy pregnant women with term singleton fetuses randomized at birth to either immediate cord clamping (ICC) (≤ 20 seconds) or DCC (≥ 5 minutes). Follow-up at 12 months of age consisted of blood work for serum iron indices and lead levels, a nonsedated magnetic resonance imaging (MRI), followed within the week by neurodevelopmental testing.

Results At birth, 73 women were randomized into one of two groups: ICC (the usual practice) or DCC (the intervention). At 12 months, among 58 active participants, 41 (80%) had usable MRIs. There were no differences between the two groups on maternal or infant demographic variables. At 12 months, infants who had DCC had increased white matter brain growth in regions localized within the right and left internal capsules, the right parietal, occipital, and prefrontal cortex. Gender exerted no difference on any variables. Developmental testing (Mullen Scales of Early Learning, nonverbal, and verbal composite scores) was not significantly different between the two groups.

Conclusion At 12 months of age, infants who received DCC had greater myelin content in important brain regions involved in motor function, visual/spatial, and sensory processing. A placental transfusion at birth appeared to increase myelin content in the early developing brain.

Key Points

  • DCC resulted in higher hematocrits in newborn period.

  • DCC appears to increase myelin at 12 months.

  • Gender did not influence study outcomes.

Keywords

umbilical cord - iron - placental transfusion - delayed cord clamping - myelin

Supplementary Material



Publication History

Received: 15 March 2020

Accepted: 09 June 2020

Article published online:
21 July 2020

© 2020. Thieme. All rights reserved.

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