Debra Erickson-Owens, a certified nurse-midwife at Women & Infants Hospital, a Care New England facility, is co-principal investigator of the Infant Brain Study, in which researchers are examining the brain development during the first two years of life in babies who have immediate umbilical cord clamping compared to babies whose clamping was delayed.
Erickson-Owens, who holds a doctorate in nursing from the University of Rhode Island, is also a research scientist in the department of pediatrics at Women & Infants and an associate professor at URI. She spoke recently with Providence Business News about the Infant Brain Study, which is being funded by the National Institutes of Health and the Eunice Kennedy Shriver National Institute of Child Health and Human Development.
PBN: Can you explain the scope and purpose of the Infant Brain Study; how many women were involved in the study at Women & Infants Hospital?
ERICKSON-OWENS: The Infant Brain Study is examining the effects of the timing of umbilical cord clamping on early brain development. At an infant’s birth, the obstetrics provider can decide to clamp and cut the baby’s umbilical cord immediately or can wait a few minutes before clamping. Immediate cord clamping is the most common practice in the United States. Previous studies have found that delaying a few minutes can allow the return of the infant’s own blood, including iron-rich blood cells, from the placenta. This return of blood can increase an infant’s iron stores, and iron is necessary for early brain development. Low iron levels can be associated with anemia and subsequent neurodevelopmental delay in some children.
In our study, we enrolled 122 healthy, full-term women and their infants and compared immediate clamping, before 20 seconds of birth, with delaying clamping for five minutes. We are following the children’s brain development over the first two years of life. This study is unique, as we are using magnetic resonance imaging – without sedation – to watch the children’s brain growth at 4, 12 and 24 months of age.
PBN: What inspired you to focus on this particular issue?
ERICKSON-OWENS: My interest rests in clinical practice. As a nurse-midwife, I have had the good fortune to assist in births many, many times. It is as a witness to this amazing event that I draw my inspiration. I was also inspired by my research partner, Judy Mercer, a certified midwife and a professor emeritus at URI. More than 30 years ago, she observed a distressed infant at birth and saw the infant make a quick recovery after waiting a few minutes before clamping the umbilical cord. In those first few minutes, the infant not only received more blood, but also red blood cells and stem cells. I am personally committed to contributing to research that can improve infant health using low-tech, low-cost practices right from the start, at the time of birth.
PBN: You began this study in 2012 and it’s due to continue through 2017; what preliminary findings have you learned?
ERICKSON-OWENS: We have had some very exciting findings. As expected, at 2 days of age, the infants who had a five-minute delay in cord clamping had less blood left behind in the placenta and better hematocrit levels (a lab test used to tell us about iron) than did those infants who had immediate cord clamping. At 4 months of age, the infants who received the five-minute delayed clamping had better iron stores (nearly double) and better brain development in the areas of the brain associated with motor, visual and sensory functions. No risks to this simple practice have been identified during our study.
PBN: Independent of deliveries associated with this study, have obstetrics providers at Women & Infants typically adhered to one practice or another – immediately at birth or shortly thereafter birth – for umbilical cord clamping?
ERICKSON-OWENS: Immediate clamping is still the dominant practice at Women & Infants. However, as the mounting evidence seems to indicate benefits associated with a delay, we see that more obstetrics providers are adopting delayed cord clamping. We are currently conducting a cord clamping survey of all Women & Infants’ OB providers about their individual cord clamping practices. We hope that this will provide insight as to why providers do or don’t practice delayed cord clamping at Women & Infants.
PBN: Have any preliminary results surprised or concerned you; how do you envision the results of the study affecting obstetricians’ clamping procedures in the future?
ERICKSON-OWENS: As earlier mentioned, we are very excited about the 4-months’ findings and the association between iron levels and brain development. The study is still ongoing and we look forward to the 12- and 24-months’ findings. We will continue to share preliminary findings as they become available. If the study yields positive results showing that a short delay leads to better brain development, we hope this will contribute to more and more providers adopting the practice. I believe we can all agree that any practice that leads to better infant brain development without causing harm should be adopted, not only at Women & Infants but around the world.
