Original Article

The Impact of Umbilical Cord Clamping Time on the Infant Anemia: A Randomized Controlled Trial


Background: Anemia during infancy causes irreversible physical, cognitive, motor, and behavioral development disorders. This study aimed to determine the effect of delaying umbilical cord clamping time on certain parameters regarding anemia during the infancy.

Methods: This randomized controlled trial was conducted at a university hospital in west of Turkey (Dec 2017-Dec 2018). Overall, 110 participants were evaluated for the research, 65 participants were randomized after excluding those who did not meet the inclusion criteria (intervention=32, control=33). Randomly assigned to delayed clamping (1 min after delivery) or early clamping (in 15 sec after delivery), and followed up until 4 months postpartum. 48th-hour hematocrit, bilirubin values, need for phototherapy and hematocrit, hemoglobin values, diagnosis of anemia at the postnatal fourth month were compared between two groups. The data showing normal distribution were assessed using the parametric tests. The level of statistical significance was determined as P<0.05.

Results: The 48th-hour hematocrit and bilirubin levels of the intervention group were significantly higher than the control (P<0.01 and P<0.05, respectively). No significant difference regarding the need for phototherapy due to postnatal hyperbilirubinemia was observed between the two groups (P>0.05). Means of the intervention group hematocrit and hemoglobin levels measured during anemia screening performed at the fourth month were found to be higher than those of the infants in the control group (P<0.05 and P<0.05, respectively).

Conclusion: Delaying umbilical cord clamping had a positive impact on the haematological parameters of infants. Clamping the cord at least one minute in birth can be performed to prevent the iron deficit anemia that could be seen during the first years of infants’ lives.

1. Turkish Hematology Association (2011). Di-agnosis and treatment guide for iron de-ficiency anemia in children. Istanbul: Turkish Hematology Association.
2. Andersson O, Lindquist B, Lindgren M, et al (2015). Effect of delayed cord clamping on neurodevelopment at 4 years of age: A randomized clinical trial. JAMA Pediatr, 169 (7): 631-8.
3. Chaparro MC, Neufeld LM, Alavez GT, et al (2006). Effect of umbilical cord clamping on iron status in Mexican infants: a randomised controlled trial. Lancet, 367(9527):1997-2004.
4. Gokmen Z. Effects of delayed umbilical cord clamping on peripheral haematological parameters and peripheral blood haematopoietic stem cells in premature neonates [PhD thesis]. Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Baskent University, Ankara; 2010.
5. Yigit MB, Kowalski WJ, Hutchon DJR, et al (2015). Transition from fetal to neonatal circulation: modeling the effect of umbilical cor clamping. J Biomech, 48(9):1662-70.
6. Kluckow M, Hooper SB (2015). Using physiology to guide time to cord clamping. Semin Fetal Neonatal Med, 20(4):225-31.
7. Pisicane A (1996). Neonatal prevention of iron deficiency. BMJ, 312(7024): 136–137.
8. Chaparro MC (2011). Timing of umbilical cord clamping: effect on iron endowment of the newborn and later iron status. Nutr Rev, 1:S30-6.
9. Todorich B, Pasquini JM, Garcia CI, et al (2009). Oligodendrocytes and myelination: the role of iron. Glia, 57(5):467-78.
10. Republic of Turkey Ministry of Health (2012). Infant and Child Monitoring Protocols. Access: https://dosyaism.saglik.gov.tr/Eklenti/9010,bebek-cocuk-izlem-protokolleri pdf .pdf? Date of Access: 31.03.2019
11. World Health Organization (WHO). (2014). Guideline: delayed umbilical cord clamping for improved maternal and infant health and nutrition outcomes. Geneva: World Health Organization.
12. Karatas Baran, G, Sahin S (2019). Effect of Delayed Umbilical Cord Clamping on Newborn Health. Journal of Duzce University Health Sciences Institute, 9 (2): 95-101.
13. Ceriani Cernadas J, Guillermo C, et al (2006). The effect of timing of cord clamping on neonatal venous hematocrit values and clinical outcome at term: a randomized, controlled trial. Pediatrics, 117 (4): e779-86.
14. Ahmad K, Aly SA, Zahran, SA (2012). Effect of early versus late umbilical cord clamping of term ınfants on maternal and neonatal outcomes. J Am Sci, 8 (9): 1935-1941.
15. Emhamed MO, van Rheenen PF, Brabin BJ (2004). The early effects of delayed cord clamping in term infants born to Libyan mothers. Trop Doct, 34 (4): 218-22.
16. Venancio, SI, Levy RB, Saldiva SRDM, et al (2008). Effects of delayed cord clamping on hemoglobin and ferritin levels in infants at three months of age. Cad Saude Publica, 24 (2): S323-31.
17. van Rheenen PF, Gruschke S, Brabin BJ (2006). Delayed umbilical cord clamping for reducing anaemia in low birthweight infants: implications for developing countries. Ann Trop Paediatr, 26 (3): 157-67.
18. McDonald SJ, Middleton P, Dowswell T, et al (2008). Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. Cochrane Database Syst Rev, 2013(7):CD004074.
19. Rincon D, Foguet A, Rojas M, et al (2014). Time of cord clamping and neonatal complications, a prospective study. An Pediatr (Barc), 81(3):142-8.
20. Nouraie S, Amir Ali Akbari S, Vameghi R, et al (2019). The effect of the timing of umbilical cord clamping on hemoglobin levels, neonatal outcomes and developmental status in infants at 4 months old. Iran J Child Neurol, 13 (1): 45-55.
21. Korukcu O, Avgoren G (2016). The effect of delayed umbilical cord clamping and cord milking on health of newborn. Journal of Anatolia Nursing and Health Sciences, 19 (Special Issue): 46-52.
22. Hutton EK, Hassan ES (2007). Late vs early clamping of the umbilical cord in full-term neonates: systematic review and meta-analysis of controlled trials. JAMA, 297 (11): 1241-52.
23. Gedikoglu G, Agaoglu L (1993). Haematological Diseases. In: Paediatry Vol 2. Ed, O Neyzi, T Ertuğrul. Nobel Medical Publishers, İzmir, Turkey, pp: 347-363.
24. Arsan S, Cullas Ilarslan NE, Gunay F (2016). The importance of iron prophylaxis in the first two years of life and the measurement of ferritin in anemia screening with hemogram: can it be part of routine screening? Ankara University Scientific Research Project Final Report, pp: 1-16. Access: acikarsiv.ankara.edu.tr› Date of Access: 10.09.2019
25. Akgunes, E. Examination of erythrocyte index RDW and MCV as iron deficiency screening test in children [Master thesis]. Republic of Turkey Ministry of Health Bakırkoy Dr. Sadi Konuk Training and Research Hospital, İstanbul; 2004.
26. Giardina B, Messana I, Scatena R, et al (1995). The multiple functions of hemoglobin. Crit Rev Biochem Mol Biol, 30 (3): 165-96.
27. Kayiran SM, Gurakan B (2010). Effect of iron deficiency on motor development and cognitive functions in children. TAF Preventive Medicine Bulletin, 9 (5): 529-534.
28. Ouellette Landynn E (2016). Delayed umbilical cord clamping: a state of the science. Senior Honors Projects, 253. Access: https://commons.lib.jmu.edu/honors201019/253
29. Rabe H, Diaz-Rossello JL, Duley L, et al (2012). Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes. Cochrane Database Syst Rev, 9(9):CD003248.
30. Begley CM, Gyte GML, Devane D, et al (2015). Active versus expectant management for women in the third stage of labour. Cochrane Database Syst Rev, 2(2):CD007412.
IssueVol 50 No 5 (2021) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/ijph.v50i5.6116
Umbilical cord Clamping Infant Anemia Midwifery

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How to Cite
Güner S, Karaca Saydam B. The Impact of Umbilical Cord Clamping Time on the Infant Anemia: A Randomized Controlled Trial. Iran J Public Health. 50(5):990-998.