URI Department of Communications and = Marketing

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Department of = Communications=20 and Marketing
Division of University = Advancement
Alumni=20 Center, 73 Upper College Road, Kingston, Rhode Island = 02881
Phone:=20 401-874-2116 / Fax: 401-874-7872

Federal government backs expanded URI research on = benefits of=20 delayed umbilical cord clamping

Media Contact: Dave Lavallee, = 401-874-5862

$2 million grant to aid promising study by URI = nursing=20 professor

KINGSTON, R.I. =96 March 19, 2008 = =96 A division=20 of the National Institutes of Health has awarded a = University of=20 Rhode Island nursing professor a $2 million, 5-year grant to = continue her investigation into the benefits of delaying = umbilical=20 cord clamping for pre-term infants.

The National = Institute=20 for Nursing Research is funding the project, which will be = conducted=20 at Women & Infants Hospital in Providence.

The = nursing=20 research agency provided $392,000 for a smaller, earlier = project=20 involving 72 mother-infant pairs, which showed that a brief = delay in=20 clamping the umbilical cords of babies born before 32 weeks = prevents=20 bleeding in the brain and infections. The findings garnered=20 international attention.

=93That was a Phase One = study, which=20 allowed us to test the protocols and make some initial = findings,=94=20 said the principal investigator, Judith Mercer, a URI = clinical=20 professor of nursing and certified nurse-midwife. =93But to = have=20 delayed cord clamping become part of clinical practice in = hospitals=20 around the nation, we needed to complete larger = studies.=94

"Preliminary data in support = of this=20 application has already shown that this simple and straight = forward=20 maneuver may improve neonatal outcomes," said James F. = Padbury, MD,=20 pediatrician-in-chief at Women & Infants=20 Hospital.

Current obstetrical practice in the United = States=20 for very low birth weight infants is to clamp umbilical = cords=20 immediately. But Mercer said when immediate cord clamping = occurs,=20 more than 25 percent of the fetal-placental blood volume may = be left=20 in the placenta, acutely increasing vulnerability to = hypovolemia, a=20 loss of blood and fluids that can lead to shock. The earlier = study=20 showed that there were fewer cases of intraventricular = hemorrhage=20 and infection among those babies whose cords were clamped = after a=20 brief delay. Male infants showed even greater benefits from = delayed=20 cord clamping. However, the study may have been too small to = find=20 negative effects of delayed cord clamping.

=93Of the=20 approximately 57,000 infants born annually at less than 1500 = grams,=20 10 percent develop cerebral palsy and 25 to 50 percent show = later=20 cognitive and behavioral deficits affecting school = performance, with=20 higher rates found in males,=94 Mercer said.

The new = study will=20 involve 212 infants to validate earlier positive findings = and to=20 identify the causes of such benefits through the study of = biologic=20 markers, including measurement of immunoregulatory proteins, = circulating stem cells and red cell volume.

The = infants will=20 be selected randomly starting in April for inclusion in a = control=20 group in which cords will be clamped immediately, or an = experimental=20 group in which cord clamping will be delayed 30 to 45 = seconds. In=20 the experimental group, the infants will also be held lower = than the=20 placenta, which allows gravity to move more umbilical cord = blood=20 into the baby.
=93We are going to measure the amount of = stem cells=20 in the cord blood one hour after birth and in the body 24 = hours=20 later,=94 Mercer said. =93The theory is that if the baby = gets additional=20 cord blood, they will get more stem cells which may help = prevent=20 infection. Earlier work shows that this procedure may result = in=20 preterm babies needing fewer blood = transfusions.=94

Each baby=20 will be followed until they are seven months of age, with an = assessment of motor outcome planned at the = conclusion.

=93This=20 low tech change in clinical practice has the potential to = reduce the=20 risk of disease and disability and to improve the neonatal = and early=20 childhood outcomes for these most vulnerable preterm = infants,=94=20 Mercer said. =93This area of research comes from 30 years of = work as a=20 practicing nurse-midwife. I have always delayed cord = clamping in my=20 practice with term infants.=94

The nursing professor = said she=20 wants to expand her research to study the effects of delayed = cord=20 clamping and =93milking=94 the umbilical cord (manually = moving the blood=20 from the cord to the baby) at time of caesarean section, and = look at=20 the effects of delayed cord clamping on full-term=20 infants.

Her leadership in such research is being = noted=20 around the world. Mercer said a group of researchers in = Australia is=20 planning a large study to begin in 2009, and Mercer has been = asked=20 to serve as a consultant.

Among her collaborators = for the $2=20 million federal study are: URI Psychology Professor Joseph = Rossi of=20 the URI Cancer Prevention Research Center, statistical = consultant;=20 URI Nursing Professor Mary Sullivan, chair of the study=92s = Data=20 Safety and Monitoring Committee; and from Women & = Infants=20 Hospital, James Padbury, MD, and William Oh, MD, = neonatologists;=20 Betty Vohr, MD, development pediatrician; and Stephen Carr, = MD,=20 maternal fetal medicine specialist. Vineet Bhandar at Yale = will be=20 analyzing biological markers and Paul McMillan of Rhode = Island=20 Hospital=92s Core Research Laboratory will be doing the red = cell=20 measurement.

Pictured above
Judith Mercer, = URI=20 clinical professor of nursing and certified nurse-midwife, = left,=20 with Roxanne Rodrigues and her baby Selena, in the Neonatal=20 Intensive Care Unit at Women & Infants Hospital. Born at = 26=20 weeks, Selena would have been eligible for Mercer=92s study. = URI=20 Department of Communications and Marketing photo by Michael = Salerno=20 Photography

Also, the smaller image above = links to the=20 NBC = 10 Health Check Video center where you can select = the=20 "Umbilical Cord Study, March 19" link to view the report = (2:33).=20

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