Associate professor Lund University halmstad, Hallands Lan, Sweden
Background: After birth, neonates receive a placental transfusion of approximately 30% of their total blood volume when umbilical cord clamping (CC) is delayed. Beneficial effects of delayed CC include increased iron stores, improved brain myelin content during infancy and slightly improved motor performance at 4 years. However, there are no studies following up children after delayed versus early CC beyond 4 years of age. Objective: To explore long-term behavioral consequences of early vs delayed CC in school-aged children. The hypothesis was that early CC would be associated with an increased risk of behavioral problems. Design/Methods: Exploratory, long-term follow-up study of a randomized controlled trial in the Hospital of Halland, Sweden. Children born at full-term were originally randomized to either delayed (≥180 sec) or early (≤10 sec) CC. At 10 years of age, total and subgroup scores of the Swanson, Nolan and Pelham Scale-IV (SNAP-IV), a screening questionnaire for attention deficit hyperactivity disorder (ADHD), and the Autism Spectrum Screening Questionnaire (ASSQ), were compared between groups of early and delayed CC. Results: We assessed 122 children (47.3% of potential follow-up), 59 in early CC and 63 in delayed CC. No significance was seen when comparing early and delayed CC. However, early CC was associated with significantly more girls above cut-off for inattentive subgroup in SNAP-IV, n = 4 vs n = 0, P =. 037. There was no difference for boys.
Conclusion(s): Overall, early CC was not associated with an increased risk for behavioral problems in 10-year-old children. We found a higher proportion of risk for inattentive behaviour in girls who had early CC compared to delayed. Studies with higher follow-up rate and studies performed in populations with high prevalence of iron deficiency are needed. Understanding if delayed CC have long-lasting neurobehavioral effects can help develop guidelines and programmes about umbilical cord management.
