Effects of Delayed Cord Clamping on 4-Month Ferritin Levels, Brain

Myelin Content, and Neurodevelopment: A Randomized Controlled Trial

Judith S. Mercer, PhD, Debra A Erickson-Owens, PhD, Sean C.L. Deoni, PhD, Douglas C, II, PhD, et.al
 Analisis PICO

Problem Intervention Comparison Outcome

• Efek Delayed Cord • Tindakan Delayed • Tindakan Immediate • Kadar feritin pada DCC
Clamping (DCC) Cord Clamping (DCC) Cord Clamping (ICC) lebih tinggi dibandingkan
yang memfasilitasi ( > 5 menit). ( < 20 detik) dengan ICC (96,4 ng/dL vs
65,3ng/dL)
transfusi plasenta
terhadap kadar • Substansi myelin di otak
ferritin, substansi pada kapsula interna, dan
myelin di otak, dan regio lain terkait fungsi
perkembangan motorik, visual dan
sistem saraf pada sensoris lebih tinggi pada
bayi usia 4 bulan. DCC dibandingkan ICC

• Perkembangan otak yang

dinilai dengan Skoring
Mullen tidak menunjukkan
perbedaan hasil antara
DCC dan ICC (105.1 vs
103.5)
 BACKGROUND

DCC at birth increases blood volume and iron rich red cell volume.

ICC decreases early iron stores  Iron deficiency  cognitive, motor, social-emotional,
and behavioral development.

Oligodendrocyte require iron for both maturation and function to form myelin

Hypothesized: the infants born at term exposed to placental transfusion via DCC (or cord
milking) would have greater iron stores and enhancd myelin formation showing
increased myelin content at 4 mo of age compared with infants with ICC
 METHODS

Intervention, Healthy and term pregnant women  DCC (>5 min) & ICC (<20 sec).
Randomization, And A during SC or if the provider could not perform DCC  milking 5 times
Blinding
Participant Follow Four data collection points at 4 mo of age: well-baby pediatric visit,Iron
Up profil (ferritin), MRI, and neurodevelopmental testing

Sample Size Previous study : ferritin levels after DCC, 30 sample/group

Statistical Analysis 2 sided pearson x2 test, 2-sample t test, and wilcoxon rank sum test

Image Analysis and Association b/w VFm and 4 mo blood ferritin levels were evaluated at
Statistical Testing each image using GLM, included age, gestasional age, birthweight
 RESULT

•Cord clamping time

(includes UCM) (p=0.002)

•Cord clamping time

(without UCM) (p= <0.001)

•RPBV mL/kg (p=0.05)

 Result

•Two day ht % (57.6 vs

53.1) (p= 0.01)
•Ferritin ng/dL (96.4 vs 65)
(p=0.03)
•Log ferritin (4.4 vs 4.1)
(p=0.03)
RESULT
RESULT
 DISCUSSION

• Infant receiving DCC having increased Myelin water volume fraction in similar brain
regions associated with the blood ferritin levels  it suggest a direct neurophysiological
link between DCC and early myelin development

•The results suggest placental transfusion at birth may result in increased iron stores,
represented by ferritin, and may help promote myelination in the first few months of
life.
THANK YOU 