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Effect of Placental Transfusion on Iron Stores in Moderately Preterm Neonates of 30–33 weeks Gestation

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Abstract

Objective

To assess the effect of placental transfusion by delayed cord clamping (DCC) of 60 s or cord milking (CM) on serum ferritin levels at hospital discharge and 3 mo of postmenstrual age (PMA) in preterm neonates of 30 to 33 wk gestation in comparison to early cord clamping (ECC) within 10 s.

Methods

This mixed longitudinal study was conducted in moderately preterm neonates of 30 to 33 wk gestation born in a level III unit in Northern India with the study sample nested within a randomized controlled trial on placental transfusion. Intervention was delayed cord clamping for 60 s or cord milking compared with early cord clamping (within 10 s). Primary outcome measure was serum ferritin levels at discharge. Secondary outcome measures were serum ferritin levels at 3 mo PMA, incidence of anemia, need for blood transfusion and incidence of iron deficiency by 3 mo PMA.

Results

Out of the 215 randomly chosen infants, serum ferritin levels were estimated at least at one time point (at discharge or at 3 mo PMA) in 197 neonates [placental transfusion – 107; early cord clamping – 90]. Amongst them, ferritin level was estimated at discharge in 141 neonates, at 3 mo PMA in 76 neonates and at both time points in 20 neonates. Median (IQR) serum ferritin (μg/L) at discharge was significantly higher in placental transfusion group in comparison to the ECC group [399 (309,600) (n = 79) vs. 254 (190,311) (n = 62); p < 0.001]. Median (IQR) ferritin level at 3 mo PMA was not different between the study groups [20 (14,57) (n = 39) vs. 24 (8,52) (n = 37); p = 0.2]. The incidence of anemia by 3 mo PMA was significantly lesser in the placental transfusion group. No difference was observed in anemia requiring blood transfusion and iron deficiency by 3 mo PMA between the groups.

Conclusions

In 30 to 33 wk preterm neonates, placental transfusion resulted in significantly higher serum ferritin at discharge in comparison to early cord clamping. However, this benefit did not persist till 3 mo PMA.

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Abbreviations

CM :

Cord milking

DCC :

Delayed cord clamping

ECC :

Early cord clamping

ELISA :

Enzyme linked immunosorbent assay

PMA :

Post-menstrual age

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Authors and Affiliations

  1. Neonatal Unit, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India

    Bikramjit Das, Venkataseshan Sundaram & Praveen Kumar

  2. Newborn Unit, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India

    Venkataseshan Sundaram

  3. WINNER Centre for Newborn Research, NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia

    William T. Mordi

  4. Neonatal Unit, Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India

    Lakhbir K. Dhaliwal

  5. Neonatal Unit, Department of Hematology, Post Graduate Institute of Medical Education and Research, Chandigarh, India

    Reena Das

Authors
  1. Bikramjit Das
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  2. Venkataseshan Sundaram
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  3. Praveen Kumar
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  4. William T. Mordi
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  5. Lakhbir K. Dhaliwal
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  6. Reena Das
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Contributions

BD: Collected the data, conducted the study, analyzed the data and drafted the initial manuscript; VS: Conceptualized and designed the trial, designed the data collection tool, supervised conduct of the trial, analyzed the data and critically reviewed the manuscript and approved the final manuscript; PK: Conceptualized and designed the trial and the data collection tool, supervised conduct of the trial, critically reviewed and approved the final manuscript; WTM: Conceptualized the study, critically reviewed and approved the final manuscript; LKD: Significantly contributed in the trial design, supervised the conduct of the trial, critically reviewed and approved the final manuscript; RD: Performed measurement of ferritin values, assisted in data analysis, critically reviewed and approved the final manuscript. PK will act as guarantor for this paper.

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Correspondence to Venkataseshan Sundaram.

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Das, B., Sundaram, V., Kumar, P. et al. Effect of Placental Transfusion on Iron Stores in Moderately Preterm Neonates of 30–33 weeks Gestation. Indian J Pediatr 85, 172–178 (2018). https://doi.org/10.1007/s12098-017-2490-2

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  • DOI: https://doi.org/10.1007/s12098-017-2490-2

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