| ObjectiveTwo objectives are concerned on iron deficiency anemia problems of infants in our research, one is to establish the the cut-off values to diagnosis iron deficiency and iron deficiency anemia of4,6months old infants with basic breast-feeding.Another objective is to deal with the problem that if delayed umbilical cord clamping could increase the iron storage of neonate and if this effect can last for4to6months and discuss the possible side effects of this intervention strategy.We collected term delivery women with normal iron nutritional status from Beijing maternity hospital affiliated to Capital Medical University and the people’s hospital of Beijing university under the principle of informed consent. Vein blood were sampled from infants at r birth,4months,6months. Iron status index such as hemoglobin (Hb), mean corpuscular volume (MCV), serum ferritin(SF), serum transferrin receptor(sTfR) and zinc protoporphyrin (ZPP) were tested of babies with normal birth weight and were basic breast-feeding within4months.Babies were randomly divided into one control group and one iron supplement group which were given a two month iron supplement with a dose of lmg/kg/bw/d at the age of4months or6months,the changes of hemoglobin were observed after iron supplement.Cut-off values of nutritional status indexes were established by set a population with normal iron nutrition. Three meathod were used by to build the healthy population:One was the unselected population-infants who fufill our enter criterion (the control group), anther was the selected population-infants of the control group which excluded the possible iron deficeny infants. The other was iron supplement population-the iron supplement group which were given preventional iron supplement. Infants with hemoglobin changes>10g/L were considered as iron difeciency before iron supplement and excluded.The distribution of iron nutritional indexes in the three population were compared and analyzed, the cut-off values to diagnosis iron deficiency and iron deficiency anemia of4,6months old infants with basic breast-feeding were established according to the analysis.At the same time, we conducted delayed umbilical cord clamping (1or2minutes after shoulder delivery) for full-term pregnancy healthy women. Iron status and growth and development condition at the age of3days,4,6months were compared with the front conventional cord clamping group(less than15seconds after shoulder delivery). Bleeding volume of partunients, infants suffering from glycethemia, hyperbrilirubinemia and needed light therapy were recorded to discuss the side effects of delyed umbilical cord clamping.Meanwhile we collected full-term and cesarean delivery women with normal iron nutritional status, the babies’iron status, growth and development condition at the age of3days and4,6months were compared with those broned by normal childbirth mentioned above.Results1. The establish of cut-off values for iron nutritional indexesA total of285infants were followed at4months and119at6months, we had established the distribution threshold of iron status indexes and the cut-off values to diagnosis iron deficiency and iron deficiency anemia of4,6months old infants according to the three methods. The cut-off values were as follows:Hb<101g/L, MCV<72fl, SF<13μg/L, sTfR>6mg/L, sTfR/SF>363and sTfR/lgSF>1.3for4-month infants; Hb<102g/L, MCV<70fl, SF<9μg/L, sTfR>7mg/L, sTfR/SF>912and sTfR/lgSF>1.3for6-month infants. 2. The effect of delayed cord clamping(DCC)At4months, a total of297mother-infant pairs completed this study, including97of1-minute delayed cord clamping (DCC) group,37of2-minute delayed cord clamping group and163of immediate cord clamping (ICC) group. At6months, a total of138mother-infant pairs completed this study, including38,18,82in the three groups, respectively.There was no Statistically significant difference at the age, gestational weeks, BMI, Hb, MCV of mothers, born weight and stature of babies(P>0.05) in the comparison for the basic condition of the mother-infant pairs.The Hct of the1-minute DCC group was higher than that of ICC group (0.54±0.05vs0.51±0.06) and there was statistically significant difference between them (P<0.05). There was no statistically significant difference at the Hb, MCV, SF and sTfR in the comparison of3-day venous iron indexbetween the two groups, but Hb, MCV, SF of the1-minute DCC group had the higher trend and sTfR with a lower trend. there was nobody with anemia (Hb<145g/L) and7infants(7/162,4.3%) in the ICC group, there was statistically significant difference at the anemia incidence (P<0.05).At4months, MCV, SF of the1-minute DCC group and2-minute DCC had the higher trend compared with the ICC group, but there was no statistically significant difference between them.And there was no statistically significant difference of all the other indexes between the three groups.At6months, SF of the1-minute DCC group and2-minute DCC had the higher trend compared with the ICC group, but there was no statistically significant difference between them.And there was no statistically significant difference of all the other indexes between the three groups.3. The side effects of delayed cord clampingIn the ICC group,5patients(4.1%) in the enrolled121patients occured postpartum haemorrhage, no severe postpartum haemorrhage.In the DCC group,8 patients(7.7%) in the enrolled104patients occured postpartum haemorrhage,2patients(1.9%) occurred severe postpartum haemorrhage.There is no statistical significance between the two groups (p>0.05).There was1infant (0.83%) who had polycythemia in the ICC group, there also1ocurred in the DCC group (0.97%),but there was no statistical significance between them (p>0.05).In the ICC group, there was47infants (38.8%) with hyperbilirubinemia,58infants (47.9%) needed phototherapy; In the DCC group,there was20patients (19.2%) with hyperbilirubinemia,44patients (42.3%) needed phototherapy. After statistical analysis,the incidence of hyperbilirubinemia in ICC group was higher than the other group, it was statistically significant.But the rate of patients who need phototherapy was similar to each other,and thee was no statistical significance between the two groups (p>0.05)4. The effect of different delivery ways on the iron nutritional status of infantsThe Hb concentration of the3-day normal delivery infants was much higher than that of cesarean infants (183.38±17.63g/L versus172.60±17.30g/L) and there was statistical significance (P=0.01). At4months, the sTfR concentration the median of which was2.50mg/L(95%reference range0.78±6.81mg/L) in the normal delivery group was lower than that in the cesarean group the median of which was3.67mg/L (95%reference range1.15～7.98mg/L) and the difference had statistical sense(p0.001).Conclusions1. The cut-off values we established for full term, breast-fed and4,6months old infants could provide scientific data for the prevention, diagnosis and intervention of iron deficiency and provide population materials for the diatery reference intakes(DRIs) formulation. 2. Delayed umbilical cord clamping1and2minutes after the shoulder delivery could increase the Hct and prevention anemia of the3-day neonates.We haven’t found that delayed umbilical cord clamping1and2minutes after the shoulder delivery has the effect on the infants’ iron status an4and6months.3. Normal delivery could increase the iron nutritional level compared with cesarean section of3-day neonates and4-month old infants. |
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