延迟断脐对足月母乳喂养婴儿4月龄时铁营养状况及生长发育的影响

The effects of iron stores and growth of delayed umbilical cord clamp timing on term breast-fed infants at 4-month-old

目的研究出生时延长新生儿的断脐时间对婴儿4月龄时铁营养状况和生长发育的影响。方法选取孕期健康的孕妇，按照抽签法随机分为常规断脐组（94名，产后15S内断脐）和晚断脐组（64名，产后1min断脐）。追踪至4月龄，分别检测4月龄时婴儿静脉血铁营养状况及生长发育各项指标，监测婴儿早期胆红素水平。结果在4月龄时，晚断脐组婴儿血清铁蛋白中位数为87.30ug／L，平均红细胞容积为（79．62±4．13）fl，分别高于正常断脐组婴儿的64．3ug/L和（78．06±4．38）fl，差异均有统计学意义（Z=-2．36，t=2．23，P值均〈0．05）。晚断脐组婴儿血细胞比容为（33．59±2．48）％，高于正常断脐组婴儿的（32．76±2．69）％（t=1．95，P=0．05）。其他铁营养指标以及婴儿体重、身长差异无统计学意义（P值均〉0．05）。在分别以血红蛋白（Hh）〈105异／L和Hb〈110g／L为贫血判定界值时，晚断脐组贫血的发病率分别是6．25％（4／64）、21．86％（14／64）；正常断脐组分别为12．77％（12／94）、34．04％（32／94），差异无统计学意义（P值均〉0．05）。结论延长断脐时间至1min能够改善足月母乳喂养婴儿4月龄时的铁贮存状况；对其生长发育无明显不良影响。

Objective To explore uhether delayed umbilical cord clamp timing of newborn can improve iron stores of infant period and growth and development. Methods Mother-infant pairs were randomly assigned to early clamping （94 cases, 〈 15 s after delivery） and delayed clamping （64 cases, 1 min after delivery） by draw lots, and followed up until 4 months postpartum. Infant hematological status,iron status, the level of growth and development of infants after 4 months were measured respectively. Transcutaneous hilimbin at the third day after delivery was also measured. Results At 4 mouths age, the median of serum ferritin and mean of corpuscular volume value in delayed group were 87.30 ug/L and （79.62 ± 4. 13 ） fl, significantly higher than the values in early group （ 64. 3 ug/L, （ 78.06 ± 4. 3g ） fl）, respectively （ Z = - 2.36, t = 2. 23, both P values 〈 0. 05 ）. The hematocrit value was （ 33.59 ± 2.48 ） % , higher than that in early group （32.76 ± 2. 69）% （t = 1.95, P = 0. 05 ）. There was no statistically significant difference at other iron nutrition indicators and infants＇ weight and body length at 4 months （P 〉0. （15）. Under the different cut-off values （hemoglobin （Hb） 〈 105 g/L and Hb 〈 110 g/L, respectively ）, the prevalence of anemia in delay and early clamping group were 6. 25% （4/64）, 21.86% （14/64）, and 12. 77% （ 12/94）, 34. 04% （32/94） , respectively （ both P values 〉 0. 05 ） . Conclusion Delayed umbilical cord clamp timing until I rain can improve iron stores of breastfed infants at 4 months;there is no significant adverse effects to growth.