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and Marketing
Division of University Advancement
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Center, 73 Upper College Road, Kingston, Rhode Island 02881
Phone:
401-874-2116 / Fax: 401-874-7872

Federal government backs expanded URI research on benefits of
delayed umbilical cord clamping

Media Contact: Dave Lavallee,
401-874-5862

$2 million grant to aid promising study by URI nursing
professor

KINGSTON, R.I. – March 19, 2008 – A division
of the National Institutes of Health has awarded a University of
Rhode Island 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.

“That was a Phase One study, which
allowed us to test the protocols and make some initial findings,”
said the principal investigator, Judith Mercer, a URI clinical
professor of nursing and certified nurse-midwife. “But to have
delayed cord clamping become part of clinical practice in hospitals
around the nation, we needed to complete larger studies.”

"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.

“Of 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,” 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.
“We are going to measure the amount of stem cells
in the cord blood one hour after birth and in the body 24 hours
later,” Mercer said. “The 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.”

Each baby
will be followed until they are seven months of age, with an
assessment of motor outcome planned at the conclusion.

“This
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,”
Mercer said. “This 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.”

The nursing professor said she
wants to expand her research to study the effects of delayed cord
clamping and “milking” 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: URI Psychology Professor Joseph Rossi of
the URI Cancer Prevention Research Center, statistical consultant;
URI Nursing Professor Mary Sullivan, chair of the study’s 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’s Core Research Laboratory will be doing the red cell
measurement.

Pictured above
Judith Mercer, URI
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’s study. URI
Department of Communications and Marketing photo by Michael Salerno
Photography

Also, the smaller image above links to the
NBC
10 Health Check Video center where you can select the
"Umbilical Cord Study, March 19" link to view the report (2:33).

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