Effect of Umbilical Cord Clamping Time on Nutrition Status of Infants: A Randomized-Controlled Trial in Longisa Hospital, Bomet County, Kenya
Bor, Kipkorir Wesley
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Although most studies document the benefit of delaying umbilical cord clamping in relation to improved haemoglobin levels, few of those studies have been done in low resource settings. Standard routine practice in most facilities is generally clamping umblical cord in less than 60 seconds. This study therefore sought to establish the effects of umbilical cord clamping time on infant nutritional status at 6 months at Longisa County Referral Hospital through randomized controlled trial design. Sample size of n=204 of mother-infant pair was enrolled in both control and experimental group of the study. The experimental group involved clamping the umbilical cord between 3-5 minutes after delivery while the control group was clamped as per the standard routine practice in the facility. Infant’s blood sample was drawn and haemoglobin was assessed at birth, 6 weeks and 6 months. Ballard maturity assessment score was used to assess infant gestational age at birth. Weight was measured using SECA 354 and length was assed using SECA 210 length Matt. Mother -infant socio demographic characteristics collected using a validated questionnaire. A standard Pre-test questionnaire based on WHO 2014 guidelines was used to measure health workers knowledge on the umbilical cord clamping time. Data was analysed using Stata version 15.1 and Microsoft Office Excel 2007. Mother-infant socio-demographic characteristics by the study group was compared using Pearson chi-square (p < 0.05; 95% CI). Health workers’ knowledge was analysed results presented in percentage. Third trimester maternal haemoglobin was collected in mother child booklet and analysed using Pearson chi-square. Infant haemoglobin levels at birth, 6 weeks and 6 months by study group was analysed using Pearson chi-square. The relationship between maternal and infant haemoglobin status was assessed using Pearson correlation coefficient determinant. The effect of umbilical cord clamping on infant nutritional status and haemoglobin was tested using student t-test. Predictors of infant Nutritional status at six (6) months were established using binary logistic regression model. The results are based on two-tailed tests at 95% confidence interval and a p-value p < 0.05 was used as the criterion for significance. Results were: Mean age of mothers of infants enrolled into the study was (22.73 ± 1.9; p<0.05); about 50% of health workers knew that delaying umbilical cord clamping is beneficial to the infant. Approximately 69% of health workers believe that delaying umbilical cord camping increases the HIV infection. Control group: Mean weight: at birth 2.89kgs (95% CI, 2.81-2.97), 4.81 (95% CI (4.68-4.94) at 6 weeks and 7.41kgs (95% CI, 7.28-7.54) at 6 months. Mean haemoglobin at birth was 18.72g/dl (95% CI, 18.19-19.25), 10.85g/dl (95% CI (10.58-11.12) at 6 weeks and 11.10g/dl (95% CI, 14.26-15.52) at 6 months. Experimental group: Mean weight at birth 2.93kgs, 5.22 (95% CI, 4.99-5.22) and 8.51 at 6 months ((95% CI, 8.40-8.60; p<0.05). Mean haemoglobin: Birth 19.67g/dl, (95% CI, 19.25-20.09), 11.72(95% CI, 11.45-11.99) and 12.22g/dl (11.95-12.49 at 6 months ((95% CI, 8.40-8.60; p<0.05). Predictor of infant nutritional status at 6 months were weight (OR14.90, p<0.05; 95% CI: 7.25-30.00) and infant haemoglobin (OR1.64, p<0.05; 95% CI: 1.3-2.07). The study concluded that delaying the umbilical cord clamping improved infant Nutritional status and haemoglobin. Setting optimal time to clamp the umblical cord is important for Kenyan health facilities.