Abstract

Delayed umbilical cord clamping appears to be beneficial for term and preterm infants. In
term infants, delayed umbilical cord clamping increases hemoglobin levels at birth and
improves iron stores in the first several months of life, which may have a favorable effect
on developmental outcomes. There is a small increase in jaundice that requires
phototherapy in this group of infants. Consequently, health care providers adopting
delayed umbilical cord clamping in term infants should ensure that mechanisms are in
place to monitor for and treat neonatal jaundice. In preterm infants, delayed umbilical
cord clamping is associated with significant neonatal benefits, including improved
transitional circulation, better establishment of red blood cell volume, decreased need for
blood transfusion, and lower incidence of necrotizing enterocolitis and intraventricular
hemorrhage. Delayed umbilical cord clamping was not associated with an increased risk
of postpartum hemorrhage or increased blood loss at delivery, nor was it associated with
a difference in postpartum hemoglobin levels or the need for blood transfusion. Given the
benefits to most newborns and concordant with other professional organizations, the
American College of Obstetricians and Gynecologists now recommends a delay in
umbilical cord clamping in vigorous term and preterm infants for at least 30-60 seconds
after birth. The ability to provide delayed umbilical cord clamping may vary among
institutions and settings; decisions in those circumstances are best made by the team
caring for the mother-infant dyad.

A n estimated 20 percent of American children will have anemia at some

point in their childhood.(1 Anemia is defined as a hemoglobin (Hgb) concentration

or red blood cell (RBC) mass less than the 5th percentile for age. Hgb levels vary
by age, and many laboratories use adult norms as references; therefore, the
patients Hgb level must be compared with age-based norms to diagnose anemia 2
(Table 13).
Anemia is usually classified based on the size of RBCs, as measured by the mean
corpuscular volume (MCV). Anemia can be microcytic (MCV typically less than 80
m3 [80 fL]), normocytic (80 to 100 m3 [80 to 100 fL]), or macrocytic (greater
than 100 m3[100 fL]). The RBC distribution width is a measure of the size
variance of RBCs. A low RBC distribution width suggests uniform cell size, whereas
an elevated width (greater than 14 percent) indicates RBCs of multiple sizes.

Iron deficiency anemia during infancy and childhood is concerning due to its
potentially detrimental effect on development, some of which may be
irreversible even after iron treatment(Grantham McGregor S, Ani C. a review of
studies on the effect of iron deficiency on cognitive development in children. J
Nutr. 2001;131:649-66.).Maternal iron status, infant birth weight and gestational
age, as well as the timing of umbilical cord clumping at birth contribute to the
establishment of adequate total body iron at birth (Chaparro CM. Setting the
stage for child health and development prevention of iron deficiency in early
infancy. J Nutr. 2008;138:2529-33.). the prevalence of IDA was reported to be 3
time more frequent in infants who underwent early cord clumping (Cerinani
Cernadas JM, CarroliG, Pellegrini L, Ferreira M, et al. the effect of early and
delayed umbolical ord lumping on ferritin levels in term infants at six months of
life: : a randomized, controlled trial. Arh Argent Pediatr. 2010; 108:201-8.).