University of Rhode Island Professor of Nursing Judith S. Mercer, already knows from her earlier work that delaying the clamping of pre-term babies’ umbilical cords results in better overall health for the babies.
Now, the National Institutes of Health wants her to find out if doing the same for full-term babies will result in health benefits as well. The national health agency has awarded Mercer a five-year, $2.4 million grant to continue her work. The research project, known as the Infant Brain Study, also recently received a $100,000 grant from the Bill & Melinda Gates Foundation.
The Infant Brain Study grant is part of the overall $3.8 million in federal grants awarded to the College of Nursing announced October 4, 2012 during a press conference.
Mercer and her research team will study 128 infants from birth to 24 months to measure the effect of placental transfusion on the structure and functioning of the developing brain.
Debra Erickson-Owens, a co-principal investigator, assistant professor of nursing at URI and certified nurse midwife, said about one-third of the blood is left in the placenta if the cord is clamped immediately.
"The difference between delayed cord clamping and immediate clamping is 60 to 80 milliters of blood or 12 blood tubes (the tubes one sees when blood is drawn in a lab).” Erickson-Owens said. “That means with immediate clamping the babies receive less blood meant to be used in the earliest stages of development.
The NIH grant comes just three-and-half years after the agency awarded Mercer a $2 million, five-year grant to expand her investigation into the benefits of delaying umbilical cord clamping for pre-term infants. She and her research team are now compiling data and findings from that research.
A pilot study showed strong evidence that delaying cord clamping allows the pre-term infant to absorb essential nutrients that help ward off infection and bleeding in the brain. In the pilot and expanded nationally funded study, babies born pre-term had their cord clamping delayed 30 to 45 seconds.
In the new study, Mercer and her team want to find out whether delaying umbilical cord clamping for full-term infants by five minutes allows the placenta to transfer iron-rich blood cells to the newborn, reducing iron deficiency and anemia in the baby’s first year. She also wants to determine if delayed clamping enhances myelination in the brain, which is a process that requires iron to form a myelin sheath around a nerve allowing impulses to move more quickly. It leads to more complex brain processes and is critical to a healthy nervous system.
As with past studies, Mercer is working closely with Women & Infants Hospital, and she and Erickson-Owens are teaming up with Sean C.L. Deoni, director of the Advanced Baby Imaging Laboratory at Brown University.
Mercer, also a certified nurse midwife, said the delay time has been increased from the 30 to 45 second range for pre-term babies to five minutes for full-term babies for two main reasons: full-term babies do not usually need immediate and sometimes lifesaving interventions, and it allows a full placental transfusion when a baby is held skin-to-skin on its mother.
“We have been hoping for years to expand our research to full-term, healthy babies, but we needed a strong evaluation tool,” Mercer said.
That tool is magnetic resonance imaging (MRI) to chart each baby’s brain development, which will be provided by Deoni at Brown’s Advanced Baby Imaging Laboratory.
“Dr. Deoni is the first in the world to examine newborn brain development using MRI,” Mercer said. “If delayed cord clamping is shown to benefit all infants, then this new model of obstetrical care will go global.”
Current obstetrical practice at birth in the United States calls for cutting the infant’s umbilical cord immediately.
When immediate clamping occurs, 20 to 40 percent of the fetal-placental blood volume is left behind, according to the researchers. The blood contains enough iron-rich red cells to meet the infant’s iron needs for the first four to six months of life. Delaying clamping has been shown to increase the amount of iron in the blood without leading to any adverse effects for the infant.
Blood infused with iron is essential to long-term neurologic health, while iron deficiency in infancy adversely affects cognitive, motor, socio-emotional and behavioral development.
Babies participating in the study will be examined at birth, four months, 10 months and two years to assess their brains’ development.
“Delaying just a few minutes doesn’t cost anything,” Erickson-Owens said. “And while the baby is on the mother’s abdomen, skin-to-skin, the placenta can continue to support the baby while he or she gets used to the new environment.”
“And each baby will be presented a stuffed Rhody the Ram to welcome them into the world and to get them ‘Thinking Big’ from the start,” Mercer said with a smile.
Participants must be 18 years of age or older, at least 30 weeks pregnant, have a healthy pregnancy, plan to breastfeed, and plan to deliver at Women & Infants Hospital. For information, call (401) 453-0089 or visit www.womenandinfants.org/infantbrainstudy.