Influencia del tiempo de ligadura del cordón umbilical en la morbilidad secundaria neonatal y los depósitos de hierro en el neonato

El déficit de hierro es el déficit nutricional más frecuente a nivel mundial y constituye un importante problema de salud pública, principalmente en los países más desfavorecidos. La causa más frecuente de anemia en el mundo es la deficiencia de hierro. Los períodos críticos donde los requerimientos son elevados son el primer año de vida, la adolescencia y el embarazo. El pinzamiento demorado aumenta los depósitos de hierro en los RN, que les garantiza una disponibilidad de este mineral durante los primeros meses de vida, periodo crucial del desarrollo de múltiples sistemas como el SNC. , pero también se le se asoció con un aumento de la policitemia neonatal, ictericia patológica con necesidad de fototerapia y aumento del distrés respiratorio. El objetivo general fue evaluar la relación entre pinzamiento del cordón umbilical precoz (PP), y el demorado (PD), con la morbilidad secundaria neonatal y los depósitos de hierro en las cuatro primeras semanas de vida -periodo neonatal-. Se diseñó un ensayo clínico aleatorizado (ECA) con asignación aleatoria de los sujetos participantes en dos grupos. Estudio aprobado por el CEIC Hospital Universitario de La Plana y registrado en ClinicalTrials.gov (NCT03624335). El tamaño muestral se calculó con un error alfa y un poder estadístico (1-beta) del 80%. Número de participantes mínimo de cada grupo era de 78. La población de estudio la constituyeron los recién nacidos a término (RNT) y pretérminos tardíos mayores de 35 semanas de gestación y sus madres, que cumplieron los criterios de selección -inclusión y exclusión-, aceptaron participar en el estudio y firmaron el consentimiento informado. La variable independiente fue el tiempo de ligadura o pinzamiento del cordón umbilical. Las principales variables dependientes fueron los marcadores analíticos del nivel de hierro en los compartimentos funcional y de depósito junto con la morbilidad neonatal -policitemia, ictericia y distrés respiratorio-. Las muestras de sangre se obtuvieron de la vena del cordón umbilical y vena antecubital del codo. En el análisis estadístico de los resultados se utilizó el programa Stata V.14. En nuestro estudio, el PD del cordón aumentó los valores de ferritina en durante el periodo neonatal de forma significativa, sin aumentar los valores de bilirrubina, ictericia patológica ni distrés respiratorio. El PP se asoció de forma significativa a situación de anemia en el periodo neonatal. El PD no afecto al pH cordón ni aumento sangrado. Depositar a los RNT y prematuros tardíos sobre el abdomen-tórax materno, ralentizó la transferencia de sangre placentaria. Nuestro ECA valoró la repercusión del tiempo de pinzamiento del cordón umbilical en la práctica clínica habitual de la atención a un parto normal de RNT y pretérminos tardíos, con el RN colocado piel con piel, sobre el abdomen-tórax materno. El pinzamiento demorado del cordón umbilical, debería ser el estándar en la atención del parto normal para los RNT y pretérminos tardíos.Iron deficiency is the most frequent nutritional deficiency worldwide and constitutes an important public health problem, mainly in low income countries. The most frequent cause of anemia in the world is iron deficiency. The critical periods where requirements are high are the first year of life, adolescence and pregnancy. Delayed clamping increases deposits of iron in newborns, which promotes availability of this mineral during the first months of life, a crucial period in the development of multiple systems such as the Central Nervous System. But it was also associated with an increase in neonatal polycythemia, pathological jaundice with phototherapy requirement and increased respiratory distress. The objective of this study is to evaluate the relationship between early umbilical cord clamping (EC) and delayed clamping (DC), with morbidity and iron stores in the first four weeks of life -neonatal period-. An RCT was designed with random assignment of the participants into two groups. Study was approved by the Hospital Universitario de La Plana Ethics Committee and was registered at ClinicalTrials.gov (NCT03624335). The sample size is calculated with an alpha error and a statistical power (1-beta) of 80%. The minimum number of participants in each group was 78. The population of the study were term newborns (TNB) and late preterm newborns older than 35 weeks of gestation and, their mothers. The independent variable was the umbilical cord clamping moment (in secons). The main dependent variables were the laboratory markers of iron level in functional and storage compartments together with neonatal morbidity - polycythemia, jaundice and respiratory distress. Blood samples were obtained from the umbilical cord vein and the antecubital vein of the elbow. The Stata V.14 program was used to perfomr statistical analysis. DC ​​significantly increased ferritin values during the neonatal period, without increasing bilirubin values, pathological jaundice or respiratory distress incidence. The EC was significantly associated with anemia in the neonatal period. The DC did not affect cord pH nor increase bleeding. Place the newborns and late premature babies on the maternal abdomen-thorax, slowed down placental blood transfer. Our RCT evaluated the impact of the time of the umbilical cord clamping in real clinical practice conditions of delivery care normal. Delayed umbilical cord clamping, should be the standard in normal delivery care for newborns and late preterms

Umbilical cord clamping time and maternal satisfaction

Objective Clamping of the umbilical cord is part of the third stage of delivery. Delayed cord clamping (DCC) is recommended due to its contribution to prevention of anaemia. There is no evidence on the effect of DCC on maternal satisfaction. The aim of this study is to evaluate the effect of different sociodemographic and obstetric factors, including the timing of cord clamping, on maternal satisfaction with the birth experience in our healthcare system. Design Pragmatic non-drug intervention study with simple random assignment of participating mothers (Clinical Trials N°: NCT03624335). Setting A public, university-level hospital in Villarreal city, eastern Spain. Participants Childbearing woman, gestation week between 35 and 42 weeks, with regular medical pregnancy checks, single pregnancy and vaginal delivery (N = 198, 80% of the women recruited). Interventions umbilical cord clamping within 60 seconds of the birth (Early cord clamping, ECC) versus umbilical cord clamping after pulsation had been ceased (Delayed cord clamping, DCC). Measurements Birth satisfaction was measured using the Mackey Childbirth Satisfaction Rating Scale (MCSRS). Additionally, sociodemographic data, degree of knowledge about the moment of clamping and type of breastfeeding data were recorded. The Mann-Whitney and Kruskal-Wallis tests for comparison of the mean of two, three, or more groups, respectively, and Chi-square and Spearman for comparison of two qualitative and quantitative variables, respectively, were used. To determine the weight of each factor of MCSRS, an exploratory factor analysis was carried out using the maximum likelihood method for factor extraction and the varimax method for factor rotation. The adequacy of the factor analysis was checked by mean of Kaiser-Meyer-Olkin test and Bartlett sphericity test. The level of significance was set at a p-value of < 0.05. Findings The average degree of satisfaction was 4.55/5 (SD: 0.37). No statistically significant difference was observed between mothers’ satisfaction according to mother level of study or mother's place of birth, while it changed significantly with age (p = 0.0398). Within the obstetric variables, satisfaction was significantly associated with spontaneous amniorrhexis, the duration of the second stage of delivery, and the Apgar value of the newborn at the first minute of life, and was independent of the number of previous pregnancies and deliveries, use of intrapartum oxytocin, epidural analgesia, episiotomy, the weight of the child at birth and type of breastfeeding. Furthermore, there was no relationship between the time of clamping and satisfaction (p = 0.5178). Key Conclusions Maternal satisfaction with the birth experience varies with the age of the childbearing woman, and some intrapartum factors and the result is not influenced by the time of clamping of the umbilical cord. Therefore, this component of the physiological management of childbirth provides additional benefits for the health of the neonate, without negative consequences on the final perception of the maternal health care received. Implications for practice If there are no reasons that justify an early umbilical cord clamping, delaying it brings benefits to the neonate, without negatively affecting the maternal assessment of the experience of childbirth

Influencia del tiempo de ligadura del cordón umbilical en la morbilidad secundaria neonatal, los depósitos de hierro en el neonato y lactante, y efectos maternos asociados

Se pretende realizar una divulgación básica de la investigación en ciencias de la salud en la primera parte. Posteriormente se explica el estudio realizado. Dos grupos aleatorizados de pinzamiento precoz y tardío de cordón umbilical y descripción de los resultados y las posibles repercusiones en la criatura nacida y en las madre