Effect of delayed cord clamping in preterm neonates born to anemic mothers on their neurophysiological maturation

Abstract Background Iron deficiency (ID) anemia is common among pregnant women in developing countries. Perinatal ID adversely affects an infant’s neurodevelopment. Delayed cord clamping (DCC) has been found to improve term infants’ iron stores and neurodevelopment. The effect of DCC on preterm neurodevelopment is not yet confirmed. Neurophysiological tests have been used to understand the maturation of the nervous system and, therefore, neurodevelopment. Aim This study aimed to determine if DCC at birth improves neurophysiological maturation in preterm neonates, evidenced by mature Brainstem Evoked Response Audiometry (BERA) at 4-month corrected age (CA) compared to infants with early cord clamping (ECC). Methods This prospective, observational study was conducted in a tertiary-level care and teaching hospital in a resource-poor setting catering to a population with a high prevalence of ID for 1 year. Inborn preterm neonates (> 28 weeks to < 36 weeks of gestational age (GA) were included if they did not meet the exclusion criteria which included maternal placenta previa, abruptio placentae, maternal Rh negative blood group, delivery between 8 pm and 8 am or on holidays, residing > 200 km from the institution, TORCH infection, meningitis, exchange transfusion, birth asphyxia, and received aminoglycoside > 7 days. Enrolled neonates were grouped as ECC or DCC based on cord management by obstetricians. Hemoglobin and serum ferritin were estimated at birth and 4 months CA. BERA was done at 4 months CA, and the groups were compared. Results Of the 69 neonates included, hemoglobin (gm/L) was higher in the DCC group (ECC, 80.67 + 8.1, versus DCC, 90.55 + 10.0; p -value < 0.005) at 4 months of age. In the ECC group, absolute latency in wave III (ECC, 3.97 + 0.79, versus DCC, 3.63 + 0.42; p = 0.0487) and wave V (ECC, 6.00 + 0.91, vs DCC, 5.38 + 0.43; p = 0.0021) were prolonged in BERA. Interpeak-latency between I–V (ECC 4.22 + 0.98 vs DCC 3.75 + 0.41; p = 0.005) and III–V (ECC 2.18 + 0.44 vs DCC 1.44 + 0.84, p = 0.001) were prolonged in the ECC group. Conclusion DCC in preterm neonates helped improve neurophysiological maturation and potentially their neurodevelopmental outcome.