{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T14:05:11Z","timestamp":1791813911379,"version":"4.3.4"},"reference-count":33,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,1,19]],"date-time":"2021-01-19T00:00:00Z","timestamp":1611014400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2021,1,19]],"date-time":"2021-01-19T00:00:00Z","timestamp":1611014400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Yamaji Fumiko Nursing Research Fund"},{"name":"Japan Academy of Midwifery\u2019s Research Fund"},{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["26670993"],"award-info":[{"award-number":["26670993"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["matern health, neonatol and perinatol"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Japanese infants have relatively higher risk of anemia and neonatal jaundice. This study aimed to assess the effects of delayed cord clamping (DCC) on the incidence of anemia during early infancy in low-risk Japanese term infants with planned exclusive breastfeeding for 4\u2009months. This study also aimed to explore the effects of DCC on neonatal jaundice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted an open-label, parallel-arm, multicenter randomized controlled trial of DCC (clamping the cord after more than a minute or pulsation stops) vs. early cord clamping (ECC; clamping the cord within 15\u2009s) at one birth center and two clinics in Japan. Low-risk pregnant women planning to have a vaginal birth and to exclusively breastfeed and term singleton infants delivered in cephalic presentation were included in this study. The primary outcome was spectrophotometric estimation of hemoglobin at 4\u2009months. Secondary outcomes were anemia incidence at 4 months, four outcomes related to neonatal jaundice, hematocrit levels, and related outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Overall, 150 pregnant women were recruited. Participants (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u2009138) were randomly allocated to two groups (DCC\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200968, ECC\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200970). There were no significant differences between the two groups in spectrophotometric estimation of hemoglobin at 4\u2009months: mean difference\u2009=\u20090.1\u2009g\/dL, 95% confidence interval\u2009\u2212\u20090.14, 0.35, DCC 12.4\u2009g\/dL, ECC 12.3\u2009g\/dL. Only the hematocrit levels on days 3 to 5 were significantly higher in the DCC group than in the ECC group: DCC 57.0%, ECC 52.6%, mean difference\u2009=\u20094.4, 95% confidence interval 2.61, 6.20. There were no significant differences in other secondary outcomes, including outcomes related to neonatal jaundice.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Among low-risk Japanese term infants with planned exclusive breastfeeding, DCC showed no significant effects on spectrophotometric hemoglobin levels at 4\u2009months compared with ECC. We observed significantly higher hematocrit levels\u00a0on days 3 to 5 in infants who underwent DCC, while these levels were within the normal range. Jaundice outcomes remained similar to those of infants who underwent ECC. Although a larger sample size is required to assess the effects of cord clamping on neonatal jaundice, DCC may prevent anemia in newborn infants.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>\n                      UMIN-CTR; UMIN000022573, 06\/01\/2016 - retrospectively registered,\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/upload.umin.ac.jp\/cgi-open-bin\/ctr\/ctr_view.cgi?recptno=R000023056\">https:\/\/upload.umin.ac.jp\/cgi-open-bin\/ctr\/ctr_view.cgi?recptno=R000023056<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s40748-021-00125-7","type":"journal-article","created":{"date-parts":[[2021,1,19]],"date-time":"2021-01-19T04:02:51Z","timestamp":1611028971000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Effects of timing of umbilical cord clamping on preventing early infancy anemia in low-risk Japanese term infants with planned breastfeeding: a randomized controlled trial"],"prefix":"10.1186","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1309-9295","authenticated-orcid":false,"given":"Eriko","family":"Shinohara","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaeko","family":"Kataoka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yukari","family":"Yaju","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,1,19]]},"reference":[{"key":"125_CR1","doi-asserted-by":"publisher","first-page":"447","DOI":"10.1111\/ped.13174","volume":"59","author":"M Hirata","year":"2017","unstructured":"Hirata M, Kusakawa I, Ohde S, Yamanaka M, Yoda H. Risk factors of infant anemia in the perinatal period. Pediatr Int. 2017;59:447\u201351.","journal-title":"Pediatr Int"},{"key":"125_CR2","volume-title":"Report of infant and toddler's physical growth","author":"Ministry of Health, Labour and Welfare","year":"2010","unstructured":"Ministry of Health, Labour and Welfare. Report of infant and toddler's physical growth 2010. http:\/\/www.mhlw.go.jp\/stf\/houdou\/2r9852000001t3so-att\/2r9852000001t7dg.pdf. Accessed 01 Dec 2019."},{"key":"125_CR3","unstructured":"Tanaka T, Nakamune T, Tamanaha E, Yamagata R. Research of using data from infant check-ups. Ministry of Health, Labour and Welfare Data base. https:\/\/mhlw-grants.niph.go.jp\/niph\/search\/NIDD00.do?resrchNum=201219019A#selectHokoku. Accessed 01 Dec 2019."},{"key":"125_CR4","doi-asserted-by":"publisher","first-page":"651","DOI":"10.1111\/ped.13588","volume":"60","author":"M Kimura","year":"2018","unstructured":"Kimura M, Kurozawa Y, Saito Y, Watanabe H, Kobayashi A, Taketani T. High prevalence of anemia in 10-month-old breast-fed Japanese infants. Pediatr Int. 2018;60:651\u20135.","journal-title":"Pediatr Int"},{"key":"125_CR5","doi-asserted-by":"publisher","first-page":"d7157","DOI":"10.1136\/bmj.d7157","volume":"343","author":"O Andersson","year":"2011","unstructured":"Andersson O, Hellstrom-Westas L, Andersson D, Domellof M. Effect of delayed versus early umbilical cord clamping on neonatal outcomes and iron status at 4 months: a randomised controlled trial. BMJ. 2011;343:d7157.","journal-title":"BMJ."},{"key":"125_CR6","doi-asserted-by":"publisher","first-page":"1997","DOI":"10.1016\/S0140-6736(06)68889-2","volume":"367","author":"CM Chaparro","year":"2006","unstructured":"Chaparro CM, Neufeld LM, Tena Alavez G, Eguia-Liz Cedillo R, Dewey KG. Effect of timing of umbilical cord clamping on iron status in Mexican infants: a randomised controlled trial. Lancet. 2006;367:1997\u20132004.","journal-title":"Lancet."},{"key":"125_CR7","first-page":"303","volume":"46","author":"N Li","year":"2012","unstructured":"Li N, Yang LC, Wu Q, Han CC, Wang L, Rong L, et al. The effects of iron stores and growth of delayed umbilical cord clamp timing on term breastfed infants at 4 months. Zhonghua Yu Fang Yi Xue Za Zhi [Chinese journal of preventive medicine]. 2012;46:303\u20136 Chinese.","journal-title":"Zhonghua Yu Fang Yi Xue Za Zhi [Chinese journal of preventive medicine]"},{"key":"125_CR8","first-page":"41","volume":"62","author":"PC Chien","year":"2015","unstructured":"Chien PC, Yang CC, Gau ML, Liu CY, Lee TY. The impact of late umbilical cord clamping on neonatal jaundice and postpartum hemorrhage: a randomized controlled trial. Hu Li Za Zhi. 2015;62:41\u201353 Chinese.","journal-title":"Hu Li Za Zhi"},{"key":"125_CR9","volume":"7","author":"SJ McDonald","year":"2013","unstructured":"McDonald SJ, Middleton P, Dowswell T, Morris PS. Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes. Cochrane Database Syst Rev. 2013;7:CD004074.","journal-title":"Cochrane Database Syst Rev"},{"key":"125_CR10","doi-asserted-by":"publisher","first-page":"1140","DOI":"10.1001\/archpedi.154.11.1140","volume":"154","author":"TB Newman","year":"2000","unstructured":"Newman TB, Xiong B, Gonzales VM, Escobar GJ. Prediction and prevention of extreme neonatal hyperbilirubinemia in a mature health maintenance organization. Arch Pediatr Adolesc Med. 2000;154:1140\u20137.","journal-title":"Arch Pediatr Adolesc Med"},{"key":"125_CR11","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1542\/hpeds.2017-0234","volume":"8","author":"MG Bentz","year":"2018","unstructured":"Bentz MG, Carmona N, Bhagwat MM, Thimmig LM, Saleh J, Eke U, et al. Beyond \"Asian\": specific east and southeast Asian races or ethnicities associated with jaundice readmission. Hosp Pediatr. 2018;8:269\u201373.","journal-title":"Hosp Pediatr"},{"key":"125_CR12","volume-title":"Newborn revival method text based on emergency revival guidelines 2010 for Japan. Revised 3rd ed","author":"S Hosono","year":"2016","unstructured":"Hosono S. Newborn revival method text based on emergency revival guidelines 2010 for Japan. Revised 3rd ed. Tokyo: Medical view Co., Ltd; 2016. Japanese."},{"key":"125_CR13","doi-asserted-by":"publisher","first-page":"200","DOI":"10.1891\/2156-5287.5.4.200","volume":"5","author":"Y Kataoka","year":"2015","unstructured":"Kataoka Y, Nakayama K, Yaju Y, Eto H, Horiuchi S. Comparison of policies for the management of care for women and newborns during the third stage of labor among Japanese hospitals, obstetricians\u2019 clinics and independent midwives\u2019 homes\/clinics. Int J Childbirth. 2015;5:200\u20139.","journal-title":"Int J Childbirth"},{"key":"125_CR14","doi-asserted-by":"publisher","unstructured":"Shinohara E, Kataoka Y. Prevalence and risk factors for hyperbilirubinemia among newborns from a low-risk birth setting using delayed cord clamping in Japan [published online ahead of print, 2020 Aug 16]. Jpn J Nurs Sci. 2020:e12372. https:\/\/doi.org\/10.1111\/jjns.12372.","DOI":"10.1111\/jjns.12372"},{"key":"125_CR15","first-page":"77","volume":"56","author":"T Takayama","year":"2015","unstructured":"Takayama T, Endo Y, Tamashiro Y, Tsujino K, Gima T, Yamada S, et al. Effects of the timing of umbilical cord clamping on physiological jaundice and hemoglobin levels in full-term infants. Japanese J Matern Health. 2015;56:77\u201386 Japanese.","journal-title":"Japanese J Matern Health"},{"key":"125_CR16","volume":"9","author":"H Rabe","year":"2019","unstructured":"Rabe H, Gyte GM, D\u00edaz-Rossello JL, Duley L. Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes. Cochrane Database Syst Rev. 2019;9:CD003248.","journal-title":"Cochrane Database Syst Rev"},{"key":"125_CR17","unstructured":"Iruka System Corporation. Mujinwari system. https:\/\/mujinwari.biz\/users\/login. Accessed 01 Dec 2019."},{"key":"125_CR18","first-page":"1741","volume":"43","author":"S Imura","year":"1985","unstructured":"Imura S. Treatment of neonatal jaundice standard of phototherapy. Nihon Rinsho. 1985;43:1741\u20138 Japanese.","journal-title":"Nihon Rinsho"},{"key":"125_CR19","volume-title":"Noninvasive estimation of hemoglobin by pulse-CO-oximetry in infants undergoing major surgery","author":"J Renner","year":"2010","unstructured":"Renner J, Broch O, Scheewe J, Gruenewald M, Bein B. Noninvasive estimation of hemoglobin by pulse-CO-oximetry in infants undergoing major surgery. San Diego: Proceedings of the Annual Meeting of the American Society of Anesthesiologists; 2010."},{"key":"125_CR20","doi-asserted-by":"publisher","first-page":"F480","DOI":"10.1136\/archdischild-2013-305699","volume":"99","author":"S Samiee-Zafarghandy","year":"2014","unstructured":"Samiee-Zafarghandy S, Feberova J, Williams K, Yasseen AS, Perkins SL, Lemyre B. Influence of skin colour on diagnostic accuracy of the jaundice meter JM 103 in newborns. Arch Dis Child Fetal Neonatal Ed. 2014;99:F480\u20134.","journal-title":"Arch Dis Child Fetal Neonatal Ed"},{"key":"125_CR21","doi-asserted-by":"publisher","first-page":"319","DOI":"10.3233\/NPM-1263112","volume":"5","author":"M Al-Tawil","year":"2012","unstructured":"Al-Tawil M, Abdel-Aal R, Kaddah A. A randomized controlled trial on delayed cord clamping and iron status at 3-5 months in term neonates held at the level of maternal pelvis. J Neonatal-Perinatal Med. 2012;5:319\u201326.","journal-title":"J Neonatal-Perinatal Med"},{"key":"125_CR22","doi-asserted-by":"publisher","first-page":"425","DOI":"10.1093\/ajcn\/65.2.425","volume":"65","author":"R Grajeda","year":"1997","unstructured":"Grajeda R, Perez-Escamilla R, Dewey KG. Delayed clamping of the umbilical cord improves hematologic status of Guatemalan infants at 2 mo of age. Am J Clin Nutr. 1997;65:425\u201331.","journal-title":"Am J Clin Nutr"},{"key":"125_CR23","volume-title":"Guideline: Delayed umbilical cord clamping for improved maternal and infant health and nutrition outcomes","author":"World Health Organization","year":"2014","unstructured":"World Health Organization. Guideline: Delayed umbilical cord clamping for improved maternal and infant health and nutrition outcomes. 2014. http:\/\/apps.who.int\/iris\/bitstream\/10665\/148793\/1\/9789241508209_eng.pdf. Accessed 01 Dec 2019."},{"key":"125_CR24","first-page":"130","volume":"39","author":"R Gupta","year":"2002","unstructured":"Gupta R, Ramji S. Effect of delayed cord clamping on iron stores in infants born to anemic mothers: a randomized controlled trial. Indian Pediatr. 2002;39:130\u20135.","journal-title":"Indian Pediatr"},{"key":"125_CR25","doi-asserted-by":"publisher","first-page":"603","DOI":"10.1111\/j.1365-3156.2007.01835.x","volume":"12","author":"P van Rheenen","year":"2007","unstructured":"van Rheenen P, de Moor L, Eschbach S, de Grooth H, Brabin B. Delayed cord clamping and haemoglobin levels in infancy: a randomised controlled trial in term babies. Tropical Med Int Health. 2007;12:603\u201316.","journal-title":"Tropical Med Int Health"},{"key":"125_CR26","first-page":"201","volume":"108","author":"JM Ceriani Cernadas","year":"2010","unstructured":"Ceriani Cernadas JM, Carroli G, Pellegrini L, Ferreira M, Ricci C, Casas O, et al. The effect of early and delayed umbilical cord clamping on ferritin levels in term infants at six months of life: a randomized, controlled trial. Arch Argent Pediatr. 2010;108:201\u20138.","journal-title":"Arch Argent Pediatr"},{"key":"125_CR27","first-page":"211","volume":"5","author":"F Moghaddam Tabrizi","year":"2015","unstructured":"Moghaddam Tabrizi F, Barjasteh S. Maternal hemoglobin levels during pregnancy and their association with birth weight of neonates. Iran J Ped Hematol Oncol. 2015;5:211\u20137.","journal-title":"Iran J Ped Hematol Oncol"},{"key":"125_CR28","doi-asserted-by":"publisher","first-page":"268","DOI":"10.5045\/br.2016.51.4.268","volume":"51","author":"EY Joo","year":"2016","unstructured":"Joo EY, Kim KY, Kim DH, Lee JE, Kim SK. Iron deficiency anemia in infants and toddlers. Blood Res. 2016;51:268\u201373.","journal-title":"Blood Res"},{"key":"125_CR29","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1111\/apa.14913","volume":"109","author":"N Rana","year":"2020","unstructured":"Rana N, Ranneberg LJ, M\u00e5lqvist M, Kc A, Andersson O. Delayed cord clamping was not associated with an increased risk of hyperbilirubinaemia on the day of birth or jaundice in the first 4 weeks. Acta Paediatr. 2020;109:71\u20137.","journal-title":"Acta Paediatr"},{"key":"125_CR30","doi-asserted-by":"publisher","first-page":"202","DOI":"10.1016\/j.wombi.2014.05.001","volume":"27","author":"M Iida","year":"2014","unstructured":"Iida M, Horiuchi S, Nagamori K. A comparison of midwife-led care versus obstetrician-led care for low-risk women in Japan. Women Birth. 2014;27:202\u20137.","journal-title":"Women Birth"},{"key":"125_CR31","doi-asserted-by":"publisher","first-page":"e779","DOI":"10.1542\/peds.2005-1156","volume":"117","author":"JM Ceriani Cernadas","year":"2006","unstructured":"Ceriani Cernadas JM, Carroli G, Pellegrini L, et al. The effect of timing of cord clamping on neonatal venous hematocrit values and clinical outcome at term: a randomized, controlled trial. Pediatrics. 2006;117:e779\u201386.","journal-title":"Pediatrics."},{"key":"125_CR32","volume-title":"Nelson textbook of pediatrics","author":"R Kliegman","year":"2016","unstructured":"Kliegman R, Stanton BF, St Geme JW III, Schor NF, Behrman RE, Nelson WE. Nelson textbook of pediatrics. 20th ed. Philadelphia: Elsevier; 2016.","edition":"20"},{"key":"125_CR33","doi-asserted-by":"publisher","first-page":"235","DOI":"10.1016\/S0140-6736(14)60197-5","volume":"384","author":"NE Vain","year":"2014","unstructured":"Vain NE, Satragno DS, Gorenstein AN, Gordillo JE, Berazategui JP, Alda MG, et al. Effect of gravity on volume of placental transfusion: a multicentre, randomised, non-inferiority trial. Lancet. 2014;384:235\u201340.","journal-title":"Lancet."}],"container-title":["Maternal Health, Neonatology and Perinatology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s40748-021-00125-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/s40748-021-00125-7\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s40748-021-00125-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,1,19]],"date-time":"2021-01-19T04:36:35Z","timestamp":1611030995000},"score":1,"resource":{"primary":{"URL":"https:\/\/mhnpjournal.biomedcentral.com\/articles\/10.1186\/s40748-021-00125-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1,19]]},"references-count":33,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["125"],"URL":"https:\/\/doi.org\/10.1186\/s40748-021-00125-7","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-96009\/v1","asserted-by":"object"}]},"ISSN":["2054-958X"],"issn-type":[{"value":"2054-958X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,1,19]]},"assertion":[{"value":"16 October 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 January 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 January 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"All study participants provided informed consent, and the study design was approved by the Institutional Review Board of St. Luke\u2019s International University, Tokyo, Japan (Approval no. 15\u2013064). The date of approval was November 20, 2015.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"5"}}