[Timing of clamping and factors associated with iron stores in full-term newborns]

An Indian perspective for umbilical cord blood haematological parameters reference interval

BACKGROUND

The Haematological Reference Intervals (RIs) are prone to vary on the basis of various factors such as altitude, age, sex, socioeconomic status, etc. These values play a major role in laboratory data interpretation and determine the necessary clinical treatment. Currently, India has no well-established RI for cord blood haematological parameters of newborns. This study aims to establish these intervals from Mumbai, India.

METHOD

A cross sectional study was conducted in a tertiary care hospital of India from October 2022 to December 2022 on healthy and term neonates having normal birth weight and born to healthy pregnant mothers. About 2 - 3 mL of cord blood was collected from the clamped cord into EDTA tubes from 127 term neonates. The samples were analysed in the haematology laboratory of the institute and the data was analysed. The upper and lower limits were determined using non-parametric method. The Mann-Whitney U test was used to compare the distribution of the parameters between sex of infant, modes of deliveries, maternal age and obstetric history. P value less than 0.05 was considered to declare statistical significance.

RESULT

The median values and 95% RI for umbilical cord blood haematological parameters of newborns were as follows: WBC = 12.35 [2.56-21.19] × 109/L, RBC = 4.34 [2.45-6.27] × 1012/L, HGB = 14.7 [8.08-21.44] g/dL, HCT = 48 [29-67]%, MCV = 109.6 [59.04-159.1] fL, MCH = 34.5 [30.54-37.79] pg, MCHC = 31.3 [29.87-32.75] %, PLT = 249 [16.97-479.46] × 109/L,LYM = 38 [17-62] %, NEU = 50 [26-74] %, EOS = 2.3 [0.1-4.8] %, MON = 7.3 [3.1-11.4], BAS = 0 [0-1]. This study found no statistically significant difference between sex of infants, except MCHC, and obstetric history. A significant difference was observed in WBC, EOS% and absolute NEU, LYM, MON and BAS by delivery type. A higher platelet count and absolute LYM was observed in the cord blood compared to venous blood.

CONCLUSIONS

For the first time, haematological reference intervals in cord blood were established for newborns in Mumbai, India. The values are applicable for newborns from this area. Larger study throughout the country is required.

Influence of Elective Cesarean Calving (with and without Dexamethasone Induction) on the Erythrogram and Iron Serum Profiles in Nellore Calves

Simple Summary

The use of elective cesarean section has become common practice in double muscled breeds of in vitro fertilized cattle and cloned calves, particularly before the onset of labor, when it is known that cesarean section negatively affects neonatal respiration and metabolic adaptation in humans and calves. However, there is a lack of information on the effects of cesarean section on the erythrogram of calves. The objectives of this study are to characterize the hematological profile of Nellore calves born spontaneously or by elective C-section (with or without induction with dexamethasone) and to verify the frequency of anemia in these animals. Our data indicate that in the first day of life there was a decrease in the number of red blood cells, hemoglobin rates, and values of the globular volume regardless of the type of birth; however, the recovery of these hematological values happened faster in zebu calves born spontaneously than in the group born by elective C-section (with or without induction). The results suggest that iron supplementation in the first month of life in Nellore calves that underwent cesarean section could be recommended to prevent the iron deficiency anemia observed in this study.

Abstract

The aim of the present study is to evaluate the erythrogram and iron serum profiles of neonatal calves born spontaneously or born by elective cesarean section with or without dexamethasone induction. The research was performed on 38 newborn Nellore calves. Three groups of calves were assigned according to the type of birth: calves born by spontaneous vaginal calving (n = 10), calves born by elective cesarean section without inducing labor (n = 14), and calves born by elective cesarean section with labor induction with dexamethasone (n = 14). Blood samples to assess red blood cell count (RBC), hemoglobin, hematocrit, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), concentration of mean corpuscular hemoglobin (MCHC), serum iron (SFe), total capacity to bind iron to transferrin (TIBIC), and transferrin saturation index (TSI) were performed at calving (0, 3, 6, and 12 h of life) and on 1, 2, 3, 5, 7, 10, 15, and 30 days of life. Regardless of the experimental group (calves born spontaneously, or born by elective cesarean section with or without dexamethasone induction), in the first day of life there was a decrease in the number of red blood cells, hemoglobin rates, and values of the globular volume. In the period of the first 10 days of life, animals from spontaneous vaginal delivery quickly recovered values of erythrocytes, hemoglobin, and packed cell volume, whereas animals born by elective C-section (induced and uninduced) did not recover as quickly in their rates of hemoglobin and packed cell volume values. In calves born by elective C-section (induced and uninduced), it was observed in their period between 10 and 30 days of life that the MCV and MCH were reduced by passing the presenting microcytic hypochromic when compared with calves obtained by spontaneous vaginal delivery. In the period between 10 and 30 days of life, the levels of SFe and TSI in animals born by elective C-section (induced and uninduced) are significantly lower. The differences in the erythrogram values between Nellore calves born spontaneously and those by elective C-section with or without induction must be considered consequent to the process of neonatal adaptation to extrauterine life. Iron supplementation in the first month of life in calves from cesarean could be recommended to prevent anemia of this iron deficiency.

Umbilical cord blood hematological parameters reference interval for newborns from Addis Ababa, Ethiopia

BACKGROUND

Several factors like altitude, age, sex, pregnancy, socioeconomic status, life style and race influence hematological reference interval (RIs), which are critical to support clinical decisions and to interpret laboratory data in research. Currently there are no well-established RIs for cord blood hematological parameters of newborns in Ethiopia. This study aims to generate RIs for umbilical cord blood hematological parameters of newborns from Addis Ababa, Ethiopia.

METHOD

A cross-sectional study was conducted from January 1 to March 31, 2019 on healthy, term newborns (37-42 weeks) with normal birth weight born to apparently healthy pregnant mothers who had met the eligibility criteria. From 139 newborns, 2-3ml cord blood was immediately collected from the clumped cord using EDTA tube. The samples were analyzed using Sysmex KX 21 hematology analyzer. Data was entered and the 2.5th and 97.5th percentiles (upper and lower reference limit) were determined using non parametric method by SPSS version 23. The non-parametric independent Mann-Whitney U test (Wilcoxon rank-sum test) was used to compare the distribution of the parameters between genders, modes of deliveries and gestational age. P value less than 0.05 was considered to declare statistical significance.

RESULT

The median values and 95 % reference interval for umbilical cord blood hematological parameters of newborns were as follows: WBC = 12.4 [6.6-19.4] x109/L, RBC = 4.51 [3.55-5.52] x1012/L, HGB = 15.8 [12.4-19.7] g/dL, HCT = 45.9[37.9-56.3]%, MCV = 102.1[83.9-111.6] fL, MCH = 35.3 [29.4-39.1] pg, MCHC = 34.3 [32.3-37.4] %, PLT = 236 [146-438] x109/L, LYM = 37.5 [16.6-63.0] %, MXD = 7.9[1.7-15.8] %, NEU = 53.7[30.3-78.4] %, RDW = 15.6[12.0-19.0]%, PDW = 11.0[9.1-15.7]% and MPV = 9.4[8.1-11.8] fL. The current study found no significant difference between genders, except RDW (P = 0.01), and gestational age group, but there was significant difference for WBC (p = 0.007), RBC (p = 0.018) and Absolute NEU (p = 0.001) by delivery type where newborns delivered through caesarean section had lower values for these three parameters compared to those with spontaneous delivery.

CONCLUSIONS

hematological reference intervals in cord blood were established for the first time from healthy newborns of Addis Ababa and its surrounding. The values are applicable for newborns from this area. Larger study throughout the country is warranted.

Hepcidin, Serum Iron, and Transferrin Saturation in Full-Term and Premature Infants during the First Month of Life: A State-of-the-Art Review of Existing Evidence in Humans

Neonates regulate iron at birth and in early postnatal life. We reviewed literature from PubMed and Ovid Medline containing data on umbilical cord and venous blood concentrations of hepcidin and iron, and transferrin saturation (TSAT), in human neonates from 0 to 1 mo of age. Data from 59 studies were used to create reference ranges for hepcidin, iron, and TSAT for full-term-birth (FTB) neonates over the first month of life. In FTB neonates, venous hepcidin increases 100% over the first month of life (to reach 61.1 ng/mL; 95% CI: 20.1, 102.0 ng/mL) compared with umbilical cord blood (29.7 ng/mL; 95% CI: 21.1, 38.3 ng/mL). Cord blood has a high concentration of serum iron (28.4 μmol/L; 95% CI: 26.0, 31.1 μmol/L) and levels of TSAT (51.7%; 95% CI: 46.5%, 56.9%). After a short-lived immediate postnatal hypoferremia, iron and TSAT rebounded to approximately half the levels in the cord by the end of the first month. There were insufficient data to formulate reference ranges for preterm neonates.

The effects of umblical cord clamping time on lymphocyte subgroups in term and late preterm infants

Aim

To evaluate the effect of umblical cord clamping time on lymphocyte subgroups in term and late preterm infants.

Material and Methods

Seventy-four infants between 34 and 41 weeks of gestation were included in the study. Of these, 37 were umbilical cord clamped immediately after birth and the remaining 37 were clamped after waiting one minute. Babies were divided into two groups as term and preterm. The prenatal, natal, postnatal characteristics of the infants were recorded. Hematologic and lymphocyte subgroups were investigated in cord blood and venous blood at day 7. Lymphocyte subgroups were evaluated using flow cytometry.

Results

With the delay of cord clamping, the leucocytes count and the percentage of CD3+T lymphocytes in cord blood of preterm infants decreased and this decrease continued at day 7. On the contrary, CD19+B lymphocyte levels in the cord blood of preterm infants increased, and this increase continued at day 7. Also, the percentage of CD4+T lymphocytes of preterm infants decreased with the delay of cord clamping at day 7. There was no difference between groups for the rate of sepsis development.

Conclusion

With the delay of cord clamping, the leucocytes count, the percentage of CD3+T, and CD4+T lymphocytes decreased, and the percentage of CD19+B lymphocytes increased in preterm infants. The delay in cord clamping time in term and preterm infants seems to have no impact on the rate of sepsis development. Larger series of studies are needed to assess the effect of these findings on the development of infection in late preterm infants who have delayed cord clamping.

Effect and safety of timing of cord clamping on neonatal hematocrit values and clinical outcomes in term infants: A randomized controlled trial

OBJECTIVE

To evaluate the effect and safety of different umbilical cord clamping (UCC) timing.

STUDY DESIGN

This was a randomized trial of 720 term mothers/infants from the Tianjin Central Hospital of Obstetrics and Gynecology delivered from December 2014 to May 2015 and randomized to immediate cord clamping (ICC) within 15 s, delayed cord clamping (DCC) by 30, 60, 90, 120, 150, or 180 s, or when the umbilical cord pulsation ceased.

RESULTS

24 h after delivery, the mean infant hematocrit levels were 56.5, 57.3, 58.8, 59.7, 59.5, 59.7, 60.3, and 61.0% in the ICC, 30, 60, 90, 120, 150, and 180-second DCC, and no pulsation groups, respectively (P = 0.021, 0.001, 0.003, 0.001, <0.001, and <0.001, respectively; standard deviations ranging 5.4-8.7%). There was no significant difference between the 30-second DCC and ICC groups. No significant differences were found in other neonatal and maternal outcomes among these groups.

CONCLUSION

For term infants, DCC increases the hematocrit values, without apparent harmful effects on the infants and their mothers.