Effect of Infant Placement on Iron Stores in Infancy: A Pilot Study

The Effect of Infant Placement at Delivery on Iron Stores in Early Infancy: A Pilot Study

This is a pilot study designed to assess the safety of placing an infant on the mother's abdomen at the time of delivery, prior to clamping the umbilical cord and the effect of placing the infant on the mother's abdomen on the infant's iron stores. It is possible that placing the infant on the mother's abdomen (above the placenta) may lower the infant's iron stores during early infancy.

Study Overview

• Status: Unknown
• Conditions: Anemia; Iron Deficiency
• Intervention / Treatment: Procedure: perineum maintained; Procedure: abdominal placement

• Study Type: Interventional
• Enrollment (Anticipated): 30
• Phase: Not Applicable

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: Female

Description

Inclusion Criteria:

• healthy pregnant women
• 37 - 42 weeks of gestation
• vaginal delivery
• prenatal care initiated prior to 20 weeks of gestation

Exclusion Criteria:

• maternal diabetes
• intrauterine growth restriction
• hypertensive disorders of pregnancy
• chronic hypertension requiring medical therapy
• Apgar score less than 7 at 5 minutes
• unusual bleeding prior to delivery
• alloimmunization
• maternal hemoglobinopathy
• need for immediate infant resuscitation preventing adherence to protocol

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: perineum; infants maintained at the level of the perineum until umbilical cord clamping	Procedure: perineum maintained; infants maintained at the level of the perineum until umbilical cord clamping
Experimental: abdomen; infants placed on the maternal abdomen prior to cord clamping	Procedure: abdominal placement; infants placed on the maternal abdomen prior to umbilical cord clamping

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
serum ferritin level at 4 months of age	4 months

Secondary Outcome Measures

Outcome Measure	Time Frame
blood parameters (hemoglobin and hematocrit)	2 months and 4 months
serum ferritin at 2 months	2 months
blood parameters (hemoglobin and hematocrit) at 24 hrs of age	24 hrs.

Collaborators and Investigators

• Sponsor: Davison, James, D.O.
• Investigators: Principal Investigator: James M Davison, DO, Warren General Hospital; Principal Investigator: Sunny A Thomas, MD, Warren General Hospital

Publications and helpful links

General Publications

• 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.
• Lozoff B, Beard J, Connor J, Barbara F, Georgieff M, Schallert T. Long-lasting neural and behavioral effects of iron deficiency in infancy. Nutr Rev. 2006 May;64(5 Pt 2):S34-43; discussion S72-91. doi: 10.1301/nr.2006.may.s34-s43.
• Lozoff B, Georgieff MK. Iron deficiency and brain development. Semin Pediatr Neurol. 2006 Sep;13(3):158-65. doi: 10.1016/j.spen.2006.08.004.
• Grant CC, Wall CR, Brewster D, Nicholson R, Whitehall J, Super L, Pitcher L. Policy statement on iron deficiency in pre-school-aged children. J Paediatr Child Health. 2007 Jul-Aug;43(7-8):513-21. doi: 10.1111/j.1440-1754.2007.01128.x.
• Beard J. Recent evidence from human and animal studies regarding iron status and infant development. J Nutr. 2007 Feb;137(2):524S-530S. doi: 10.1093/jn/137.2.524S.
• McCann JC, Ames BN. An overview of evidence for a causal relation between iron deficiency during development and deficits in cognitive or behavioral function. Am J Clin Nutr. 2007 Apr;85(4):931-45. doi: 10.1093/ajcn/85.4.931.
• Burden MJ, Westerlund AJ, Armony-Sivan R, Nelson CA, Jacobson SW, Lozoff B, Angelilli ML, Jacobson JL. An event-related potential study of attention and recognition memory in infants with iron-deficiency anemia. Pediatrics. 2007 Aug;120(2):e336-45. doi: 10.1542/peds.2006-2525.
• Walter T. Effect of iron-deficiency anemia on cognitive skills and neuromaturation in infancy and childhood. Food Nutr Bull. 2003 Dec;24(4 Suppl):S104-10. doi: 10.1177/15648265030244S207.
• Levy T, Blickstein I. Timing of cord clamping revisited. J Perinat Med. 2006;34(4):293-7. doi: 10.1515/JPM.2006.056.
• 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.
• Yao AC, Lind J. Effect of gravity on placental transfusion. Lancet. 1969 Sep 6;2(7619):505-8. doi: 10.1016/s0140-6736(69)90213-x. No abstract available.
• Grisaru D, Deutsch V, Pick M, Fait G, Lessing JB, Dollberg S, Eldor A. Placing the newborn on the maternal abdomen after delivery increases the volume and CD34 cell content in the umbilical cord blood collected: an old maneuver with new applications. Am J Obstet Gynecol. 1999 May;180(5):1240-3. doi: 10.1016/s0002-9378(99)70623-x.
• Pafumi C, Zizza G, Russo A, Farina M, Pernicone G, Bandiera S, Giardina P, Mangiafico L, Mancari R, Maggi I, Calogero AE, Cianci A. Placing the newborn on the maternal abdomen increases the volume of umbilical cord blood collected. Clin Lab Haematol. 2001 Dec;23(6):397-9. doi: 10.1046/j.1365-2257.2001.00377.x.
• Yao AC, Lind J. Placental transfusion. Am J Dis Child. 1974 Jan;127(1):128-41. doi: 10.1001/archpedi.1974.02110200130021. No abstract available.
• Mercer JS, Nelson CC, Skovgaard RL. Umbilical cord clamping: beliefs and practices of American nurse-midwives. J Midwifery Womens Health. 2000 Jan-Feb;45(1):58-66. doi: 10.1016/s1526-9523(99)00004-5.
• Siddappa AM, Rao R, Long JD, Widness JA, Georgieff MK. The assessment of newborn iron stores at birth: a review of the literature and standards for ferritin concentrations. Neonatology. 2007;92(2):73-82. doi: 10.1159/000100805. Epub 2007 Mar 14.
• Beard JL, Murray-Kolb LE, Rosales FJ, Solomons NW, Angelilli ML. Interpretation of serum ferritin concentrations as indicators of total-body iron stores in survey populations: the role of biomarkers for the acute phase response. Am J Clin Nutr. 2006 Dec;84(6):1498-505. doi: 10.1093/ajcn/84.6.1498.

Study record dates

Study Major Dates

• Study Start: June 1, 2008
• Primary Completion (Actual): December 1, 2008
• Study Completion (Anticipated): April 1, 2009

Study Registration Dates

• First Submitted: May 7, 2008
• First Submitted That Met QC Criteria: May 8, 2008
• First Posted (Estimate): May 9, 2008

Study Record Updates

• Last Update Posted (Estimate): December 31, 2008
• Last Update Submitted That Met QC Criteria: December 30, 2008
• Last Verified: December 1, 2008

More Information

Terms related to this study

• Keywords: anemia; iron stores; iron deficiency; placental transfusion; infancy; iron deficiency in infancy; anemia in infancy; placement of neonate
• Additional Relevant MeSH Terms: Metabolic Diseases; Hematologic Diseases; Anemia, Hypochromic; Iron Metabolism Disorders; Anemia, Iron-Deficiency; Anemia
• Other Study ID Numbers: wghjmd1