The Association Between Placental Residual Blood Volume and Two Placental Transfusion Methods After Delivery at Term

Background: Despite reports of the beneficial effects, such as increasing hemoglobin level and iron store in the neonatal period, of delayed cord clamping, or umbilical cord milking after delivery in healthy term-born infants, the duration of delayed clamping or rounds of milking in most previous reports were determined arbitrarily and varied widely across different studies.Methods: We prospectively recruited 80 women with normal singleton pregnancies at 38–40 weeks' gestation. Participants were classified according to the mode of delivery and randomly assigned to either collecting blood from the placenta by umbilical cord drainage (CD) or cord milking (CM), with the placenta left in the uterus. The volume of blood collected, the duration of CD, and the number of rounds of CM were recorded.Results: Collected placental residual blood volume positively correlated with birth weight, placental weight, and length of the cord. When 80% of the total placental residual blood volume collected was set as the threshold, more than 80% of women who delivered vaginally reached this level within 60 s of CD or seven repetitions of CM. This amount of blood could be obtained within 120 s of CD or after seven repetitions of CM in more than 80% of women who underwent cesarean delivery.Conclusion: In most women, regardless of birth weight and placental weight, more than 80% of placental residual blood volume could be collected by CD within 60 s after vaginal delivery, 120 s after cesarean delivery, and seven repetitions of CM in both vaginal and cesarean deliveries.

Optimizing iron adequacy and absorption to prevent iron deficiency anemia: The role of combination of fortified iron and vitamin C

Iron is a vital nutrient to promote the availability of tissue oxygen, cell growth and control of differentiation, and energy metabolism. Preventing Iron Deficiency Anemia (IDA) is necessary because iron is vital to central nervous system growth and development especially in the first years of life. Iron-rich complementary foods are recommended in infants around 6 months of age because iron store is depleted. Better understanding of iron absorption process and factors affecting its absorption and bioavailability is necessary to prevent iron deficiency and can be a dietary strategy to mitigate iron deficiency. Meat and iron-fortified food are the main sources of iron in the diet, and it is essential to introduce supplementary food to improve iron absorption. Additional foods such as cereals, cow milk and soybeans such as phytate, polyphenol and calcium are inhibitors which require care to prevent IDA. Ascorbic acid is an effective iron-absorbing enhancer, which is useful to reduce the effects of any known nonheme iron inhibitor. In iron-fortified foods, Combination use of vitamin C (ascorbic acid) is recommended in molar ratio of 2:1 (with cow's milk and low-phytate cereal foods) and higher molar ratio of 4:1 (with higher phytate such as soybeans).

Iron status of full-term infants in early infancy is not associated with maternal ferritin levels nor infant feeding practice

Iron deficiency (ID) in early life is associated with morbidities. Most fetal iron required for infant growth is acquired in the third trimester from maternal iron store. However, how prenatal iron level affects ferritin level in early infancy remains controversial. This study aimed to examine the associations between maternal ferritin levels and cord blood serum ferritin (CBSF) and to compare the ferritin levels between different feeding practices in early infancy. Healthy Chinese mothers with uncomplicated pregnancy and their infants were followed up at 3 months post-delivery for questionnaire completion and infant blood collection. Infants who were predominantly breastfed and those who were predominantly formula fed were included in this analysis. Serum ferritin levels were measured in maternal blood samples collected upon delivery, cord blood and infant blood samples at 3 months of age. Ninety-seven mother-baby dyads were included. Maternal ID is common (56%) while the CBSF levels were significantly higher than maternal ferritin levels. Only 3 infants (3%) had ID at 3 months of age. There were no significant correlations between maternal ferritin levels with CBSF (r=0.168, p=0.108) nor with infant ferritin levels at 3 months of age (r=0.023, p=0.828). Infant ferritin levels at 3 months were significantly and independently associated with CBSF (p=0.007) and birth weight (p<0.001) after adjusting for maternal age, parity, maternal education, infant sex and feeding practice. In conclusion, maternal ID was common upon delivery. However, maternal ferritin levels were not significantly associated with CBSF concentrations nor infant ferritin concentrations at 3 months of age.

FEASIBILITY AND OUTCOME OF DELAYED CORD CLAMPING IN TERM CESAREAN SECTION BORN NEONATES

Background: Through delayed cord clamping is recommended, it is less frequently performed in cases of cesarean sections .In this study delayed cord clamping was requested to obstetricians in term well newborn who cried at birth and followed these neonates during hospital stay and till 6 weeks of life and also compared with cases in whom early cord clamping was done. Objective:To nd out the feasibility of delayed cord clamping in term newborns delivered by cesarean section and its outcomes in rst few days of life in terms of jaundice , NICU stay and hemoglobin and serum ferritin at 6weeks of age. Setting :Tertiary care hospital (Calcutta national medical college) in department of Obstetrics from March to December,2019. Design-Prospective observational cohort study Method- During this period total 3732 cesarean sections was done on term pregnancy. Obstreticians were requested for delayed cord clamping for more than 120 seconds where baby cried at birth by a counseling session of 30 minutes. Outcome was compared with early cord clamping cases(10-15secs) at early neonatal period for jaundice ,NICU stay and at 6weeks for hemoglobin and serum ferritin. RESULTS: In 236 cases (6.37% ) it was feasible to perform delayed cord clamping after requesting obstetricians. There is no signicant difference in jaundice, morbidity, maternal postpartum haemorrhage in delayed cord clamping group in early neonatal period.Haemoglobine [11.9+- 0.5gm/dl vs 9.5 +-0.5gm/dl(p<0.01)]and ferritin[339+-102ng/ml vs 179+-99ng/ml(p<0.01)] levels were signicantly more in delayed cord clamping group at 6weeks of postnatal age. Conclusion: Feasibility of delayed cord clamping is still very low in cesarean delivery but strongly recommended for building iron store in neonates. Delayed cord clamping for 120 seconds does not increase postpartum haemorrhage in mother.

Dissecting the structural and functional roles of a putative metal entry site in encapsulated ferritins

Encapsulated ferritins belong to the universally distributed ferritin superfamily, whose members function as iron detoxification and storage systems. Encapsulated ferritins have a distinct annular structure and must associate with an encapsulin nanocage to form a competent iron store that is capable of holding significantly more iron than classical ferritins. The catalytic mechanism of iron oxidation in the ferritin family is still an open question because of the differences in organization of the ferroxidase catalytic site and neighboring secondary metal-binding sites. We have previously identified a putative metal-binding site on the inner surface of the Rhodospirillum rubrum encapsulated ferritin at the interface between the two-helix subunits and proximal to the ferroxidase center. Here we present a comprehensive structural and functional study to investigate the functional relevance of this putative iron-entry site by means of enzymatic assays, MS, and X-ray crystallography. We show that catalysis occurs in the ferroxidase center and suggest a dual role for the secondary site, which both serves to attract metal ions to the ferroxidase center and acts as a flow-restricting valve to limit the activity of the ferroxidase center. Moreover, confinement of encapsulated ferritins within the encapsulin nanocage, although enhancing the ability of the encapsulated ferritin to undergo catalysis, does not influence the function of the secondary site. Our study demonstrates a novel molecular mechanism by which substrate flux to the ferroxidase center is controlled, potentially to ensure that iron oxidation is productively coupled to mineralization.

Prevalence of Iron Deficiency Anemia in Biochemically Defined Moderate to Severely Anemic patients in a Tertiary Care Centre

Introduction: Anemia due to iron deficiency and chronic diseases is common occurrence in developing country like Nepal, the latter seen in patients with various inflammatory, autoimmune, and malignant disorders . The Intensive method of marrow iron examination, which this study has employed, provides clinically useful iron status classification in cases of functional iron deficiency. The aim of the study is to find out the prevalence of iron deficiency anemia in biochemically defined moderate to severe anemic patients in tertiary care center. Methods: A descriptive cross-sectional study was done in 43 patients who underwent bone marrow aspiration for evaluation of any cause and had moderate to severe anemia at the same time over a period of one year from Nov 2015 to 2016. Ethical clearance was obtained from Institutional Review Committee. The bone marrow iron stores were assessed by“intensive method” apart from the routinely used Gale’s method. Data was collected and entry were done in Statistical Package for Social Sciences version 24. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: The intensive grading system demonstrated normal marrow iron store in 13 (30.2%), depleted iron stores in 3 (7%), functional iron deficiency in 14 (32.6%), and combined deficiency in 13 (30.2%) patients. Mean log ferritin concentration was lower in patients with depleted iron stores (2.2μg/l) than in those with normal (2.7μg/l), and functional iron deficiency (2.4μg/l). The mean log ferritin in combined deficiency was lower than the mean log ferritin concentration in iron store deficiency (1.9μg/l). Conclusions: The prevalence of functional iron deficiency anemia was greatest when the intensive method for assessment of bone marrow iron was used, thus differentiating four different iron status categories, including functional iron deficiency, from actual iron store deficiency, avoiding unnecessary iron supplementation in the former group.

Dissecting the structural and functional roles of a vicinal iron-binding site in encapsulated ferritins

Encapsulated ferritins belong to the universally distributed ferritin superfamily, which function as iron detoxification and storage systems. Encapsulated ferritins have a distinct annular structure and must associate with an encapsulin nanocage to form a competent iron store that is capable of holding significantly more iron than classical ferritins. The catalytic mechanism of iron oxidation in the ferritin family is still an open question, due to differences in organization of the ferroxidase catalytic site and secondary metal binding sites vicinal to this. We have previously identified a metal binding site on the inner surface of the Rhodospirillum rubrum encapsulated ferritin at the interface between the two-helix subunits and proximal to the ferroxidase center. Here we present a comprehensive structural and functional study to investigate the functional relevance of this proposed iron entry site by means of enzymatic assays, mass-spectrometry, and X-ray crystallography. We show that catalysis occurs in the ferroxidase center and suggest a dual role for the secondary site, which both serves to attract metal ions to the ferroxidase center and acts as a flow-restricting valve to limit the activity of the ferroxidase center. Moreover, confinement of encapsulated ferritins within the encapsulin nanocage, while enhancing the ability of the encapsulated ferritin to undergo catalysis, does not influence the function of the secondary site.