RESUMEN
OBJECTIVE: To evaluate whether placental transfusion influences brain myelination at 4 months of age. STUDY DESIGN: A partially blinded, randomized controlled trial was conducted at a level III maternity hospital in the US. Seventy-three healthy term pregnant women and their singleton fetuses were randomized to either delayed umbilical cord clamping (DCC, >5 minutes) or immediate clamping (ICC, <20 seconds). At 4 months of age, blood was drawn for ferritin levels. Neurodevelopmental testing (Mullen Scales of Early Learning) was administered, and brain myelin content was measured with magnetic resonance imaging. Correlations between myelin content and ferritin levels and group-wise DCC vs ICC brain myelin content were completed. RESULTS: In the DCC and ICC groups, clamping time was 172 ± 188 seconds vs 28 ± 76 seconds (P < .002), respectively; the 48-hour hematocrit was 57.6% vs 53.1% (P < .01). At 4 months, infants with DCC had significantly greater ferritin levels (96.4 vs 65.3 ng/dL, P = .03). There was a positive relationship between ferritin and myelin content. Infants randomized to the DCC group had greater myelin content in the internal capsule and other early maturing brain regions associated with motor, visual, and sensory processing/function. No differences were seen between groups in the Mullen testing. CONCLUSION: At 4 months, infants born at term receiving DCC had greater ferritin levels and increased brain myelin in areas important for early life functional development. Endowment of iron-rich red blood cells obtained through DCC may offer a longitudinal advantage for early white matter development. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01620008.
Asunto(s)
Encéfalo/metabolismo , Desarrollo Infantil/fisiología , Parto Obstétrico/métodos , Ferritinas/sangre , Vaina de Mielina/metabolismo , Cordón Umbilical/cirugía , Adulto , Factores de Edad , Transfusión Sanguínea , Encéfalo/diagnóstico por imagen , Constricción , Femenino , Maternidades , Humanos , Lactante , Recién Nacido , Imagen por Resonancia Magnética/métodos , Edad Materna , Monitoreo Fisiológico/métodos , Neuroimagen/métodos , Embarazo , Pronóstico , Método Simple Ciego , Nacimiento a Término , Factores de Tiempo , Estados UnidosRESUMEN
We evaluated a subset of infants with suspected intrauterine growth restriction or birth weights small for gestational age enrolled in a study of delayed cord clamping for preterm infants. Compared with immediate clamping, delayed cord clamping was associated with no apparent harm and less suspected necrotizing enterocolitis. TRIAL REGISTRATION: ClinicalTrials.gov: NCT00818220 and NCT01426698.