Effect of Delayed Cord Clamping on Neurodevelopment at 4 Years of Age A Randomized Clinical Trial
Effect of Delayed Cord Clamping on Neurodevelopment at 4 Years of Age A Randomized Clinical Trial
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DOI：
10.1001/jamapediatrics.2015.0358
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发表时间：
2015-07-01
期刊：
影响因子：
26.1
通讯作者：
Hellstrom-Westas, Lena
中科院分区：
文献类型：
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作者：
Andersson, Ola;Lindquist, Barbro;Hellstrom-Westas, Lena
预防婴儿期缺铁可促进神经发育。Delayuci脐带钳夹（CC）可预防4 ~ 6个月龄时的铁缺乏，但12个月龄后的长期效果尚未报道。目的研究延迟CC与早期CC相比对4岁时神经发育的影响。2010年，在瑞典的一家县医院。在最初的研究中纳入的儿童（n = 382）作为低风险妊娠后出生的足月婴儿被邀请在4岁时返回进行随访。Wechsler学龄前和小学智力量表（WPPSI-111）和儿童运动评估成套测验（运动ABC）评分（2012年4月18日至2013年7月5日期间收集）由盲态心理学家进行评估。在2012年4月11日至2013年8月13日期间，父母使用年龄和阶段问卷第三版（ASQ）记录孩子的发育情况，并使用优势和困难问卷记录行为。干预随机分为延迟CC（分娩后>= 180秒）或早期CC（0.0-0.9）。延迟CC组中ASQ精细运动域（11.0% vs 3.7%; P = 0.02）和运动ABC自行车跟踪任务（12.9% vs 3.8%; P = 0.02）的结果低于截止值的儿童较少。接受延迟CC的男孩在WPPSI-III处理速度商数中有显著更高的AMD（AMD，4.2; 95% CI，0.8-7.6; P = 0.02），运动ABC自行车道任务（AMD，0.8; 95% CI，0.1-1.5; P = 0.03），和精细运动（AMD，4.7; 95% CI，1.0-8.4; P =.01）和个人-社会（AMD为4.9; 95%CI为1.6-8.3;结论和相关性与早期CC相比，延迟CC改善了4岁时精细运动的评分，尤其是在男孩中，这表明，优化CC的时间可能会影响出生在高收入国家的低风险儿童人群的神经发育。
IMPORTANCE Prevention of iron deficiency in infancy may promote neurodevelopment. Delayuci umbilical cord clamping (CC) prevents iron deficiency at 4 to 6 months of age, but long-term effects after 12 months of age have not been reported.OBJECTIVE To investigate the effects of delayed CC compared with early CC on neurodevelopment at 4 years of age.DESIGN, SETTING, AND PARTICIPANTS Follow-up of a randomized clinical trial conducted from April 16, 2008, through May 21, 2010, at a Swedish county hospital. Children who were included in the original study (n = 382) as full-term infants born after a low-risk pregnancy were invited to return for follow-up at 4 years of age. Wechsler Preschool and Primary Scale of Intelligence (WPPSI-111) and Movement Assessment Battery for Children (Movement ABC) scores (collected between April 18, 2012, and July 5, 2013) were assessed by a blinded psychologist. Between April 11, 2012, and August 13, 2013, parents recorded their child's development using the Ages and Stages Questionnaire, Third Edition (ASQ) and behavior using the Strengths and Difficulties Questionnaire. All data were analyzed by intention to treat.INTERVENTIONS Randomization to delayed CC (>= 180 seconds after delivery) or early CC (0.0-0.9). Fewer children in the delayed-CC group had results below the cutoff in the ASQ fine-motor domain (11.0% vs 3.7%; P =.02) and the Movement ABC bicycle-trail task (12.9% vs 3.8%; P =.02). Boys who received delayed CC had significantly higher AMDs in the WPPSI-III processing-speed quotient (AMD, 4.2; 95% Cl, 0.8-7.6; P =.02), Movement ABC bicycle-trail task (AMD, 0.8; 95% Cl, 0.1-1.5; P =.03), and fine-motor (AMD, 4.7; 95% Cl, 1.0-8.4; P =.01) and personal-social (AMD, 4.9; 95% Cl, 1.6-8.3; P =.004) domains of the ASQ.CONCLUSIONS AND RELEVANCE Delayed CC compared with early CC improved scores in the fine-motor at 4 years of age, especially in boys, indicating that optimizing the time to CC may affect neurodevelopment in a low-risk population of children born in a high-income country.