by Anne Eglash MD, IBCLC, FABM
Does delayed cord clamping help prevent anemia in breastfeeding infants? The American Academy of Pediatrics, in its 2010 clinical report Diagnosis and Prevention of Iron Deficiency and Iron Deficiency Anemia in Infants and Young Children (0-3 years of age) recommends that all infants receive iron supplementation until they begin eating iron-rich solids at 6 months of age.
Why is the amount of iron in breastmilk not enough for the infant? It is understandable that breastmilk is low in vitamin D, since vitamin D naturally occurs from sun exposure, and nursing women spend much more time indoors as compared to the past. Women can take enough vitamin D as a supplement to reach sufficient levels in their breastmilk. But unlike vitamin D, women cannot ingest sufficient iron to increase the iron content of their breastmilk. Why do infants need more iron than what breastmilk provides?
It appears that the answer to this question may have to do with the iron stores infants receive at birth. Research now demonstrates that if the umbilical cord is clamped too soon, the infant will not receive a sufficient transfusion of iron that he can squirrel away for the next 6-9 months until he can ingest the iron on his own. If the infant receives a generous transfer of iron from the placenta through the umbilical cord immediately after birth, then the infant won’t need as much iron in breastmilk. Low iron levels in breastmilk helps keep the iron levels in the infant gut low, which prevents dangerous intestinal bacteria from feeding off of the iron and becoming stronger.
The authors of a recent article entitled ‘Placental transfusion: a review’ review the research on delayed cord clamping and conclude that delayed cord clamping should be the normal process after birth, and that early cord clamping prevents the natural blood transfusion from the placenta to the infant.
The authors indicate that all are likely benefits of delayed cord clamping except for one:
- Improved iron stores for infants at 4-6 months
- Decreased risk of neonatal jaundice
- Enhances blood flow to the brain
- Improved heart rate
- Reduction in necrotizing enterocolitis (NEC)
See the Answer
Abstract
J Perinatol. 2016 Sep 22. doi: 10.1038/jp.2016.151. [Epub ahead of print]
Placental transfusion: a review
Katheria AC1, Lakshminrusimha S2, Rabe H3, McAdams R4, Mercer JS5,6,7
- 1Division of Neonatology, Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, CA, USA
- 2Department of Pediatrics (Neonatology), University at Buffalo, Buffalo, NY, USA
- 3Academic Department of Pediatrics, Brighton and Sussex Medical School, Brighton, UK
- 4Department of Pediatrics, University of Washington, Seattle, WA, USA
- 5Division of Midwifery, University of Rhode Island, Kingston, RI, USA
- 6Division of Midwifery, Alpert School of Medicine, Brown University, Providence, RI, USA
- 7Division of Midwifery, Women and Infants Hospital of Rhode Island, Providence, RI, USA
Abstract
Recently there have been a number of studies and presentations on the importance of providing a placental transfusion to the newborn. Early cord clamping is an avoidable, unphysiologic intervention that prevents the natural process of placental transfusion. However, placental transfusion, although simple in concept, is affected by multiple factors, is not always straightforward to implement, and can be performed using different methods, making this basic procedure important to discuss. Here, we review three placental transfusion techniques: delayed cord clamping, intact umbilical cord milking and cut-umbilical cord milking, and the evidence in term and preterm newborns supporting this practice. We will also review several factors that influence placental transfusion, and discuss perceived risks versus benefits of this procedure. Finally, we will provide key straightforward concepts and implementation strategies to ensure that placental-to-newborn transfusion can become routine practice at any institution.Journal of Perinatology advance online publication, 22 September 2016; doi:10.1038/jp.2016.151.
Milk Mob Comment by Anne Eglash MD, IBCLC, FABM
The authors of this review re-frame delayed cord clamping by describing early cord clamping as avoidable and un-physiologic, while recognizing the challenges ahead in changing clinical practice in birthing centers.
There are many advantages to delayed cord clamping, including decreased risk of iron deficiency at 4-6 months, improved cardio-respiratory status at birth, decreased risk of intraventricular hemorrhage at birth due to improved blood flow to the brain, and decreased risk of necrotizing enterocolitis.
A major concern by many health care professionals has been whether delaying cord clamping after birth will increase rates of newborn jaundice. The theory is that the transfusion of extra red blood cells to the neonate at birth will increase bilirubin as a byproduct of breaking down the extra red cells. The authors of this review cite research showing no increased risk for jaundice with delayed cord clamping.
Let’s hope that eliminating the practice of early cord clamping will reverse the recommendation of routine iron supplementation for all breastfeeding infants. It just makes common sense.