Effect of Umbilical Cord Milking on Iron Related Health Outcomes for Cesarean-Delivered Infants

NCT ID: NCT02892461

Last Updated: 2020-03-17

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

484 participants

Study Classification

INTERVENTIONAL

Study Start Date

2016-07-31

Study Completion Date

2019-04-30

Brief Summary

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This study aims to determine whether umbilical cord milking can improve iron related health outcomes for cesarean-delivered infants. Half of participants will receive umbilical cord milking, while the other half will receive routine clinical treatment and care.

Detailed Description

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In recent years, several professional organizations have recommended delayed cord clamping to improve placental transfusion for newborns born vaginally based on a series of randomized controlled studies. However, no similar recommendations are available for cesarean-delivered infants. Investigators found that cesarean-delivered infants were more vulnerable to iron deficiency and anemia compared with those born vaginally, suggesting that it is urgently needed to find a similar anemia prevention strategy for infants born by cesarean sections.

In this study, investigators aim to test whether umbilical cord milking (UCM), a potentially promising strategy for cesarean delivery, can improve iron related health outcomes for cesarean-delivered infants. A total of 450 term pregnant women who are planning to give births by cesarean sections will be enrolled from two hospitals in Hunan province and randomly assigned to either UCM group or control group. Infants will be followed up at 1, 6, 12, 18 months for the evaluation of the impact of UCM on iron deficiency, anemia, as well as growth and the developmental status of language and mental/behavioral outcomes.

Conditions

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Anemia, Iron-Deficiency

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

TRIPLE

Participants Investigators Outcome Assessors

Study Groups

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Umbilical cord milking

The cord will be cut at 25 cm from the umbilical stump within 30 seconds after the infant is taken out from the uterus and its blood will be milked to the infant gently and thoroughly in 30 seconds during resuscitation on the radiant warmer, and then the cord will be cut at 2 to 3 cm from the umbilical stump.

Group Type EXPERIMENTAL

Umbilical cord milking

Intervention Type PROCEDURE

As same as that in arm descriptions.

Routine clinical treatment and care

The cord will be dealt with routine clinical method, which means it will be cut twice within 1minute after the infant is taken out from the uterus, the first cut is on the operating table, while the second cut is on the radiant warmer.

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Umbilical cord milking

As same as that in arm descriptions.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Singleton pregnancy
* Full-term pregnancy (no less than 37 gestational weeks)
* Cesarean section before the labor starts or cesarean section after the labor starts but with cervix less than 3 cm
* Plan to take vaccines and receive routine child health care in the hospital where she gives birth

Exclusion Criteria

* Maternal hypertensive disorder
* Gestational diabetes with macrosomia
* Gestational diabetes with polyhydramnios
* Maternal severe anemia with hemoglobin less than 70 g/L
* Maternal coagulation disorders
* Fetal growth restriction
* Major congenital anomalies
* Hemolytic disease of the newborn or hydrops fetalis
* Short umbilical cord length (\< 30 cm)
* Severe cord or placenta abnormalities such as cord prolapse, true knots, placental abruption and placenta previa
* Other conditions that are not suitable for the study judged by the doctors
Minimum Eligible Age

20 Years

Maximum Eligible Age

55 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

Yes

Sponsors

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National Natural Science Foundation of China

OTHER_GOV

Sponsor Role collaborator

Hunan Provincial Maternal and Child Health Care Hospital

OTHER

Sponsor Role collaborator

Liuyang Maternal and Child Health Care Hospital

UNKNOWN

Sponsor Role collaborator

Peking University

OTHER

Sponsor Role lead

Responsible Party

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Jianmeng Liu

Professor in Epidemiology and Biostatistics; Director of Institute of Reproductive and Child Health, Peking University; Director of Office for National Maternal and Child Health Statistics of China

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Jianmeng Liu, PhD

Role: STUDY_CHAIR

Peking University

Hongtian Li, PhD

Role: PRINCIPAL_INVESTIGATOR

Peking University

Yubo Zhou, PhD

Role: PRINCIPAL_INVESTIGATOR

Peking University

Qiyun Du, MD

Role: PRINCIPAL_INVESTIGATOR

Hunan Provincial Maternal and Child Health Care Hospital

Shujin Zhou, B.S.Med

Role: PRINCIPAL_INVESTIGATOR

Liuyang Maternal and Child Health Care Hospital

Locations

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Hunan Provincial Maternal and Child Health Care Hospital

Changsha, Hunan, China

Site Status

Liuyang Maternal and Child Health Care Hospital

Guankou, Hunan, China

Site Status

Countries

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China

References

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Li HT, Trasande L, Zhu LP, Ye RW, Zhou YB, Liu JM. Association of cesarean delivery with anemia in infants and children in 2 large longitudinal Chinese birth cohorts. Am J Clin Nutr. 2015 Mar;101(3):523-9. doi: 10.3945/ajcn.114.092585. Epub 2014 Dec 24.

Reference Type BACKGROUND
PMID: 25733637 (View on PubMed)

McDonald SJ, Middleton P, Dowswell T, Morris PS. Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. Cochrane Database Syst Rev. 2013 Jul 11;2013(7):CD004074. doi: 10.1002/14651858.CD004074.pub3.

Reference Type BACKGROUND
PMID: 23843134 (View on PubMed)

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.

Reference Type BACKGROUND
PMID: 17374818 (View on PubMed)

Perlman JM, Wyllie J, Kattwinkel J, Atkins DL, Chameides L, Goldsmith JP, Guinsburg R, Hazinski MF, Morley C, Richmond S, Simon WM, Singhal N, Szyld E, Tamura M, Velaphi S; Neonatal Resuscitation Chapter Collaborators. Part 11: Neonatal resuscitation: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation. 2010 Oct 19;122(16 Suppl 2):S516-38. doi: 10.1161/CIRCULATIONAHA.110.971127. No abstract available.

Reference Type BACKGROUND
PMID: 20956259 (View on PubMed)

Committee on Obstetric Practice, American College of Obstetricians and Gynecologists. Committee Opinion No.543: Timing of umbilical cord clamping after birth. Obstet Gynecol. 2012 Dec;120(6):1522-6. doi: 10.1097/01.AOG.0000423817.47165.48.

Reference Type BACKGROUND
PMID: 23168790 (View on PubMed)

McCAUSLAND AM, HOLMES F, SCHUMANN WR. Management of cord and placental blood and its effect upon the newborn. Calif Med. 1949 Sep;71(3):190-6.

Reference Type BACKGROUND
PMID: 18137215 (View on PubMed)

SIDDALL RS, CRISSEY RR, KNAPP WL. Effect on cesarean section babies of stripping or milking of the umbilical cords. Am J Obstet Gynecol. 1952 May;63(5):1059-64. doi: 10.1016/0002-9378(52)90546-2. No abstract available.

Reference Type BACKGROUND
PMID: 14923706 (View on PubMed)

Daniel DG, Weerakkody AN. Neonatal prevention of iron deficiency. Blood can be transfused from cord clamped at placental end. BMJ. 1996 Apr 27;312(7038):1102-3. doi: 10.1136/bmj.312.7038.1102d. No abstract available.

Reference Type BACKGROUND
PMID: 8616446 (View on PubMed)

Upadhyay A, Gothwal S, Parihar R, Garg A, Gupta A, Chawla D, Gulati IK. Effect of umbilical cord milking in term and near term infants: randomized control trial. Am J Obstet Gynecol. 2013 Feb;208(2):120.e1-6. doi: 10.1016/j.ajog.2012.10.884. Epub 2012 Oct 31.

Reference Type BACKGROUND
PMID: 23123382 (View on PubMed)

Mercer JS, Erickson-Owens DA. Rethinking placental transfusion and cord clamping issues. J Perinat Neonatal Nurs. 2012 Jul-Sep;26(3):202-17; quiz 218-9. doi: 10.1097/JPN.0b013e31825d2d9a.

Reference Type BACKGROUND
PMID: 22843002 (View on PubMed)

Other Identifiers

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81571517

Identifier Type: -

Identifier Source: org_study_id

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