KINGSTON, R.I. 鈥� March 19, 2008 鈥� A division of the National Institutes of Health has awarded a 溏心vlog免费B站 nursing professor a $2 million, 5-year grant to continue her investigation into the benefits of delaying umbilical cord clamping for pre-term infants.
The National Institute for Nursing Research is funding the project, which will be conducted at Women & Infants Hospital in Providence.
The nursing research agency provided $392,000 for a smaller, earlier project involving 72 mother-infant pairs, which showed that a brief delay in clamping the umbilical cords of babies born before 32 weeks prevents bleeding in the brain and infections. The findings garnered international attention.
鈥淭hat was a Phase One study, which allowed us to test the protocols and make some initial findings,鈥� said the principal investigator, Judith Mercer, a 溏心vlog免费B站 clinical professor of nursing and certified nurse-midwife. 鈥淏ut to have delayed cord clamping become part of clinical practice in hospitals around the nation, we needed to complete larger studies.鈥�
“Preliminary data in support of this application has already shown that this simple and straight forward maneuver may improve neonatal outcomes,” said James F. Padbury, MD, pediatrician-in-chief at Women & Infants Hospital.
Current obstetrical practice in the United States for very low birth weight infants is to clamp umbilical cords immediately. But Mercer said when immediate cord clamping occurs, more than 25 percent of the fetal-placental blood volume may be left in the placenta, acutely increasing vulnerability to hypovolemia, a loss of blood and fluids that can lead to shock. The earlier study showed that there were fewer cases of intraventricular hemorrhage and infection among those babies whose cords were clamped after a brief delay. Male infants showed even greater benefits from delayed cord clamping. However, the study may have been too small to find negative effects of delayed cord clamping.
鈥淥f the approximately 57,000 infants born annually at less than 1500 grams, 10 percent develop cerebral palsy and 25 to 50 percent show later cognitive and behavioral deficits affecting school performance, with higher rates found in males,鈥� Mercer said.
The new study will involve 212 infants to validate earlier positive findings and to identify the causes of such benefits through the study of biologic markers, including measurement of immunoregulatory proteins, circulating stem cells and red cell volume.
The infants will be selected randomly starting in April for inclusion in a control group in which cords will be clamped immediately, or an experimental group in which cord clamping will be delayed 30 to 45 seconds. In the experimental group, the infants will also be held lower than the placenta, which allows gravity to move more umbilical cord blood into the baby.
鈥淲e are going to measure the amount of stem cells in the cord blood one hour after birth and in the body 24 hours later,鈥� Mercer said. 鈥淭he theory is that if the baby gets additional cord blood, they will get more stem cells which may help prevent infection. Earlier work shows that this procedure may result in preterm babies needing fewer blood transfusions.鈥�
Each baby will be followed until they are seven months of age, with an assessment of motor outcome planned at the conclusion.
鈥淭his low tech change in clinical practice has the potential to reduce the risk of disease and disability and to improve the neonatal and early childhood outcomes for these most vulnerable preterm infants,鈥� Mercer said. 鈥淭his area of research comes from 30 years of work as a practicing nurse-midwife. I have always delayed cord clamping in my practice with term infants.鈥�
The nursing professor said she wants to expand her research to study the effects of delayed cord clamping and 鈥渕ilking鈥� the umbilical cord (manually moving the blood from the cord to the baby) at time of caesarean section, and look at the effects of delayed cord clamping on full-term infants.
Her leadership in such research is being noted around the world. Mercer said a group of researchers in Australia is planning a large study to begin in 2009, and Mercer has been asked to serve as a consultant.
Among her collaborators for the $2 million federal study are: 溏心vlog免费B站 Psychology Professor Joseph Rossi of the 溏心vlog免费B站 Cancer Prevention Research Center, statistical consultant; 溏心vlog免费B站 Nursing Professor Mary Sullivan, chair of the study鈥檚 Data Safety and Monitoring Committee; and from Women & Infants Hospital, James Padbury, MD, and William Oh, MD, neonatologists; Betty Vohr, MD, development pediatrician; and Stephen Carr, MD, maternal fetal medicine specialist. Vineet Bhandar at Yale will be analyzing biological markers and Paul McMillan of Rhode Island Hospital鈥檚 Core Research Laboratory will be doing the red cell measurement.
Pictured above
Judith Mercer, 溏心vlog免费B站 clinical professor of nursing and certified nurse-midwife, left, with Roxanne Rodrigues and her baby Selena, in the Neonatal Intensive Care Unit at Women & Infants Hospital. Born at 26 weeks, Selena would have been eligible for Mercer鈥檚 study. 溏心vlog免费B站 Department of Communications and Marketing photo by Michael Salerno Photography
Also, the smaller image above links to the Video center where you can select the “Umbilical Cord Study, March 19” link to view the report (2:33).