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Iron DeficiencyNCT01245296

Early Versus Delayed Cord Clamping at Term: Outcomes in Swedish Infants

A study testing Timing of clamping the umbilical cord in people with Iron Deficiency and Neonatal Hyperbilirubinemia, run by Uppsala University at 1 site in Sweden.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Delayed clamping of the umbilical cord might prevent or slow the onset of iron deficiency by increasing the infant's iron endowment at birth. Compared with early clamping, a delay of around 2-3 min provides an additional 25-40 mL of blood per kg of bodyweight. Read more about this study

Who is it for?
Ages 37 to 42 weeksHealthy volunteers can take part
Conditions the study is for
Iron Deficiency, Neonatal Hyperbilirubinemia
What is being tested?
Timing of clamping the umbilical cord
Type of treatment
Surgery or procedure
Could I receive a placebo?
No, everyone receives an active treatment
How many people
392 participants
Where
1 siteSweden
Study dates
Apr 2008to May 2010
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 37 to 42 weeks
  • All sexes
  • Healthy volunteers accepted
  • Child

Who may be able to join

  • non-smoking mother
  • healthy mother (no hemolytic disease, no treatment with any of the following drugs: anticonvulsants, antidepressants, thyroid hormone, insulin, chemotherapy or cortisone),
  • normal pregnancy (no preeclampsia, no diabetes, no prolonged rupture of membranes or signs of infection)
  • single birth, term pregnancy (gestational age 37 +0 until 41 +6 weeks + days)
  • expected vaginal delivery with cephalic presentation
  • mother should be able to master Swedish well enough to participate in the study
  • mother should live close enough to the hospital to be ready to return for follow up after four months.

Who cannot join

  • Serious congenital malformation, syndrome or other congenital disease that can affect the outcome measures

Trial locations and contacts

1 site in 1 country.

Sweden1 site
  • Länsjukhuset i Halmstad

    Halmstad, Halland County, 30187

Other trials in Sweden

About this study

Delayed clamping of the umbilical cord might prevent or slow the onset of iron deficiency by increasing the infant's iron endowment at birth. Compared with early clamping, a delay of around 2-3 min provides an additional 25-40 mL of blood per kg of bodyweight.

The results of previous intervention studies on delayed clamping are mixed, and few followed up infants beyond the perinatal period. All longer follow up studies have been performed in low income countries. The main objectives, therefore, was to assess whether delayed cord clamping improves hematological and iron status at 4 respective 12 months of age in a large sample of full-term, Swedish infants.

The investigators also choose to investigate if the timing of clamping the umbilical cord could affect rate of infections during the first four months of life and to assess the infants development at 4 and 12 months of age.

Being tested
Timing of clamping the umbilical cord
Keywords
Umbilical cord, cord clamping, iron, Ferritin, newborn, jaundice, infant, development, infections
Medical subject headings
Iron Deficiencies, Hyperbilirubinemia, Neonatal, Jaundice, Infections

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Timing of clamping the umbilical cordProcedure or surgery

    Also called Delayed cord clamping is also called Late cord claming

    The time passed after delivery until that the midwife stops circulation in the umbilical cord with a clamp.

Study groups in NCT01245296
Study groupRoleWhat they receive
Early cord clamping (ECC)OtherEarly cord clamping consisted of early (< 10 s) clamping of the umbilical cord and obtaining blood gas samples after clamping.
Receives: Procedure: Timing of clamping the umbilical cord
Delayed cord clamping (DCC)OtherDelayed cord clamping consisted of delayed (> 180 s) clamping of the umbilical cord and obtaining blood gas samples before clamping (within 30 seconds).
Receives: Procedure: Timing of clamping the umbilical cord

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Do time for clamping the umbilical cord affect children's hemoglobin and iron status at 4 months of age?

    Using mean cell volume (MCV), mean cell hemoglobin concentration (MCHC), reticulocyte hemoglobin, serum ferritin, transferrin saturation and soluble transferrin receptors to assess iron status

    Measured: 4 months of age (plus or minus three weeks)

Secondary outcomes (11)
  1. Do the time for clamping the umbilical cord affect children's hemoglobin and iron status at 12 months of age?

    Using mean cell volume (MCV), mean cell hemoglobin concentration (MCHC), reticulocyte hemoglobin, serum ferritin, transferrin saturation and soluble transferrin receptors to assess iron status.

    Measured: 12 months of age (plus or minus one month)

  2. Are the rates of successful umbilical arterial samples equal between the groups?

    Arterial blood samples are obtained with different methods between groups: in the early clamped group samples are taken from the placental part of the clamped cord, in the delayed clamped group samples are taken before clamping in the still pulsating cord. At the same time umbilical venous samples are obtained. A arterial blood sample is assessed as successful when ph < 0.2 and partial pressure of carbon dioxide (pCO2) > 0.5 kPa compared to the venous sample.

    Measured: Immediately after birth (within 30 seconds)

  3. Is there a difference in development as assessed by the Ages and Stages Questionnaire at 4 months of age?

    Ages and Stages Questionnaire is a parent report questionnaire available for developmental screening of children from one month to 5 ½ years. 30 questions are divided into 5 developmental domains (communication, gross motor, fine motor, problem solving and personal-social). Total score and scores within separate domains from the 4-month questionnaire will be assessed.

    Measured: 4 months of age (plus or minus three weeks)

  4. Do the time for umbilical cord clamping affect incidence of infections during the first four months of life?

    After birth of their child, until four months of age parents fill out a form where they daily note if their infant has intestinal or respiratory symptoms, as well as if the infant has middle ear infection, has visited a doctor, has had an antibiotic prescription or has been admitted into a hospital.

    Measured: 4 months of age (plus or minus three weeks)

  5. Is Reticulocyte hemoglobin a useful measure of iron stores at 2-3 days of age?

    Reticulocyte hemoglobin (RetHE) is a novel measure suggested to describe iron status. Ret HE will be compared to other indicators of iron stores: mean cell volume (MCV), mean cell hemoglobin concentration (MCHC), serum ferritin, transferrin saturation and soluble transferrin receptors

    Measured: Mean 2 to 3 days of age (within 48-96 hours after birth)

  6. Do the time for umbilical cord clamping affect neonatal outcomes: anemia, polycythemia and need for phototherapy?

    Anemia defined as hemoglobin < 145 g/L, polycythemia defined as hematocrit > 0.65.

    Measured: Within 7 days after birth

  7. Is there any difference in post partum haemorrhage when using early cord clamping compared to delayed cord clamping with oxytocin administered after clamping?

    Measuring time to placental abortion, post partal hemorrhage and mothers post partum need for blood transfusion

    Measured: After giving birth until discharge from maternity ward

  8. Is there a difference in development as assessed by the Ages and Stages Questionnaire at 12 months of age?

    Ages and Stages Questionnaire is a parent report questionnaire available for developmental screening of children from one month to 5 ½ years. 30 questions are divided into 5 developmental domains (communication, gross motor, fine motor, problem solving and personal-social). Total score and scores within separate domains from the 12-month questionnaire will be assessed.

    Measured: 12 months of age (plus or minus one month)

  9. Do the time for umbilical cord clamping affect Immunoglobulin G levels at 2-3 days of age?

    Blood samples for metabolic screening are routinely taken as soon as possible after 2 days (48 hours) of age. At the same time samples for Immunoglobulin G is obtained.

    Measured: Mean 2 to 3 days of age (within 48-96 hours after birth)

  10. Is Reticulocyte hemoglobin a useful measure of iron stores at 12 months of age?

    Reticulocyte hemoglobin (RetHE) is a novel measure suggested to describe iron status. Ret HE will be compared to other indicators of iron stores: mean cell volume (MCV), mean cell hemoglobin concentration (MCHC), serum ferritin, transferrin saturation and soluble transferrin receptors

    Measured: 12 months of age (plus or minus one month)

  11. Does the time for umbilical cord clamping affect the infants respiration within the first 6 hours of life?

    Midwives observes the newborn infant at 1 hour and 6 hours of age and note presence of tachypnea (> 60 breaths/minute), grunting, nostril flaring and or retractions between or under the ribs.

    Measured: Within 6 hours after birth

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted22 Nov 2010 (estimated)
  2. Study startApr 2008
  3. Primary completionMay 2010
  4. Study completionMay 2010

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Parallel groups
Masking
Triple blind
Who is masked
Participant, Investigator, Outcomes assessor
Enrolment
392 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT01245296
Sponsor's protocol ID
NATIBAR08
Status last verified
Aug 2014
First submitted
13 Oct 2010
Last updated
20 Aug 2014
Results posted
No
Data monitoring committee
No

Publications

  • Begley CM, Gyte GM, Murphy DJ, Devane D, McDonald SJ, McGuire W. Active versus expectant management for women in the third stage of labour. Cochrane Database Syst Rev. 2010 Jul 7;(7):CD007412. doi: 10.1002/14651858.CD007412.pub2.

    PubMed 20614458
  • Chaparro CM, Fornes R, Neufeld LM, Tena Alavez G, Eguia-Liz Cedillo R, Dewey KG. Early umbilical cord clamping contributes to elevated blood lead levels among infants with higher lead exposure. J Pediatr. 2007 Nov;151(5):506-12. doi: 10.1016/j.jpeds.2007.04.056. Epub 2007 Sep 17.

    PubMed 17961694
  • Ceriani Cernadas JM, Carroli G, Pellegrini L, Otano L, Ferreira M, Ricci C, Casas O, Giordano D, Lardizabal J. The effect of timing of cord clamping on neonatal venous hematocrit values and clinical outcome at term: a randomized, controlled trial. Pediatrics. 2006 Apr;117(4):e779-86. doi: 10.1542/peds.2005-1156. Epub 2006 Mar 27.

    PubMed 16567393
  • van Rheenen P, de Moor L, Eschbach S, de Grooth H, Brabin B. Delayed cord clamping and haemoglobin levels in infancy: a randomised controlled trial in term babies. Trop Med Int Health. 2007 May;12(5):603-16. doi: 10.1111/j.1365-3156.2007.01835.x.

    PubMed 17445128
  • van Rheenen PF, Gruschke S, Brabin BJ. Delayed umbilical cord clamping for reducing anaemia in low birthweight infants: implications for developing countries. Ann Trop Paediatr. 2006 Sep;26(3):157-67. doi: 10.1179/146532806X120246.

    PubMed 16925952
  • Hutton EK, Hassan ES. Late vs early clamping of the umbilical cord in full-term neonates: systematic review and meta-analysis of controlled trials. JAMA. 2007 Mar 21;297(11):1241-52. doi: 10.1001/jama.297.11.1241.

    PubMed 17374818
  • Grajeda R, Perez-Escamilla R, Dewey KG. Delayed clamping of the umbilical cord improves hematologic status of Guatemalan infants at 2 mo of age. Am J Clin Nutr. 1997 Feb;65(2):425-31. doi: 10.1093/ajcn/65.2.425.

    PubMed 9022526
  • McDonald SJ, Middleton P. Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. Cochrane Database Syst Rev. 2008 Apr 16;(2):CD004074. doi: 10.1002/14651858.CD004074.pub2.

    PubMed 18425897
  • Mercer JS. Current best evidence: a review of the literature on umbilical cord clamping. J Midwifery Womens Health. 2001 Nov-Dec;46(6):402-14. doi: 10.1016/s1526-9523(01)00196-9.

    PubMed 11783688
  • Andersson O, Hellstrom-Westas L, Andersson D, Domellof M. Effect of delayed versus early umbilical cord clamping on neonatal outcomes and iron status at 4 months: a randomised controlled trial. BMJ. 2011 Nov 15;343:d7157. doi: 10.1136/bmj.d7157.

    PubMed 22089242
  • Andersson O, Domellof M, Andersson D, Hellstrom-Westas L. Effect of delayed vs early umbilical cord clamping on iron status and neurodevelopment at age 12 months: a randomized clinical trial. JAMA Pediatr. 2014 Jun;168(6):547-54. doi: 10.1001/jamapediatrics.2013.4639.

    PubMed 24756128
  • Andersson O, Domellof M, Andersson D, Hellstrom-Westas L. Effects of delayed cord clamping on neurodevelopment and infection at four months of age: a randomised trial. Acta Paediatr. 2013 May;102(5):525-31. doi: 10.1111/apa.12168. Epub 2013 Feb 11.

    PubMed 23336628
  • Andersson O, Hellstrom-Westas L, Andersson D, Clausen J, Domellof M. Effects of delayed compared with early umbilical cord clamping on maternal postpartum hemorrhage and cord blood gas sampling: a randomized trial. Acta Obstet Gynecol Scand. 2013 May;92(5):567-74. doi: 10.1111/j.1600-0412.2012.01530.x. Epub 2012 Oct 17.

    PubMed 22913332
  • Askelof U, Andersson O, Domellof M, Fasth A, Hallberg B, Hellstrom-Westas L, Pettersson K, Westgren M, Wiklund IE, Gotherstrom C. 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. 2017 Dec 29;7(12):e017215. doi: 10.1136/bmjopen-2017-017215.

    PubMed 29289934

Questions about this trial

What is this clinical trial studying?

A study testing Timing of clamping the umbilical cord in people with Iron Deficiency and Neonatal Hyperbilirubinemia, run by Uppsala University at 1 site in Sweden.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 7 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 20 Aug 2014. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Sweden. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Do time for clamping the umbilical cord affect children's hemoglobin and iron status at 4 months of age? (time frame: 4 months of age (plus or minus three weeks)). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT01245296, which also lists 14 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 20 Aug 2014.

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