Effects of Delayed Cord Clamping on 4-Month Ferritin Levels, Brain Myelin Content, and Neurodevelopment: A Randomized Controlled Trial

J Pediatr. 2018 Dec;203:266-272.e2. doi: 10.1016/j.jpeds.2018.06.006. Epub 2018 Jul 6.


Objective: To evaluate whether placental transfusion influences brain myelination at 4 months of age.

Study design: A partially blinded, randomized controlled trial was conducted at a level III maternity hospital in the US. Seventy-three healthy term pregnant women and their singleton fetuses were randomized to either delayed umbilical cord clamping (DCC, >5 minutes) or immediate clamping (ICC, <20 seconds). At 4 months of age, blood was drawn for ferritin levels. Neurodevelopmental testing (Mullen Scales of Early Learning) was administered, and brain myelin content was measured with magnetic resonance imaging. Correlations between myelin content and ferritin levels and group-wise DCC vs ICC brain myelin content were completed.

Results: In the DCC and ICC groups, clamping time was 172 ± 188 seconds vs 28 ± 76 seconds (P < .002), respectively; the 48-hour hematocrit was 57.6% vs 53.1% (P < .01). At 4 months, infants with DCC had significantly greater ferritin levels (96.4 vs 65.3 ng/dL, P = .03). There was a positive relationship between ferritin and myelin content. Infants randomized to the DCC group had greater myelin content in the internal capsule and other early maturing brain regions associated with motor, visual, and sensory processing/function. No differences were seen between groups in the Mullen testing.

Conclusion: At 4 months, infants born at term receiving DCC had greater ferritin levels and increased brain myelin in areas important for early life functional development. Endowment of iron-rich red blood cells obtained through DCC may offer a longitudinal advantage for early white matter development.

Trial registration: ClinicalTrials.gov: NCT01620008.

Keywords: delayed cord clamping; iron; myelin; placental transfusion; umbilical cord milking.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Factors
  • Blood Transfusion
  • Brain / diagnostic imaging
  • Brain / metabolism*
  • Child Development / physiology*
  • Constriction
  • Delivery, Obstetric / methods*
  • Female
  • Ferritins / blood*
  • Hospitals, Maternity
  • Humans
  • Infant
  • Infant, Newborn
  • Magnetic Resonance Imaging / methods
  • Maternal Age
  • Monitoring, Physiologic / methods
  • Myelin Sheath / metabolism*
  • Neuroimaging / methods
  • Pregnancy
  • Prognosis
  • Single-Blind Method
  • Term Birth
  • Time Factors
  • Umbilical Cord / surgery*
  • United States


  • Ferritins

Associated data

  • ClinicalTrials.gov/NCT01620008