|Anemia: An assist from the umbilical cord.|
Iron deficiency: You have to love a simple intervention that promises to improve the lives of many patients. Camilla Chaparro, Kathryn Dewey, and their colleagues at the University of California at Davis, the Mexican National Institute of Public Health, and the Luis Castelazo Ayala Hospital in Mexico City have given us just such a prize in a paper published in the Lancet. In developing countries perhaps half of all children become anemic by their first birthday. The cause is usually iron deficiency, related to maternal iron deficiency, maternal blood loss associated with childbirth, or early infant feeding practices using iron-poor formula or foods. The deficiency often worsens with time because of the chronic blood loss associated with many intestinal worms that infest children in the tropics, and because poor families can't afford much meat. There is some disagreement in the scientific literature, but many experts believe that anemia in early childhood has negative-and perhaps irreversible-effects on development.
The fix: Chaparro and her colleagues tested the effects on iron levels in infants of delaying the clamping of the umbilical cord until two minutes after birth. Following more than 350 infants, the researchers found that a two-minute delay (which allowed the return of about 4 ounces of the baby's blood that's temporarily held in the placenta and cord vessels) led to a substantial decrease in anemia at 6 months. The intervention was most effective for babies at greatest risk: those born to iron-deficient mothers, with low birth-weights, or who don't get iron-fortified formula.
The usual practice: The usual practice of clamping the cord right away (an average of about 17 seconds after birth in Mexico City) is standard hospital practice everywhere. The idea is that quickly clamping and cutting the cord will make it easier to attend quickly to the needs of both newborn and mother. In addition, hospitals can finish labor and delivery faster, which has some institutional advantage. And it is sometimes argued that the extra increment of blood produced by delayed cord clamping might cause the baby to wind up with too much blood in his system, increasing circulatory difficulties and the risk of jaundice. But this study did not encounter either adverse effect.
In short: an easy, free, safe intervention that is likely to give a leg up to newborns in developing countries. What more could one ask for?