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Birth, Cord Clamping, and Some Microbial Differences

Today's topic: BIRTH. Two recent studies have results that question some current medical practices, which are when to cut the umbilical cord, and hospital vs home birth differences in the baby's gut microbes.

The first study makes a case against the current practice of cutting the umbilical cord immediately after birth. University of Rhode Island researchers found that delaying umbilical cord clamping for more than 5 minutes transfers iron rich blood from the placenta to the baby (resulting in about a 30% increase in blood volume). This resulted in babies at 4 months of age having higher iron storage (ferritin) levels and increased brain myelination. Myelin is a fatty material that wraps around nerve cell fibers - think of it as insulation of the brain's wiring.

The second study found that birth at home results in a more diverse microbiome (microbial community) in the baby at birth and one month later - when compared to babies born in hospitals. This study was conducted in the Hudson Valley region of NY state. All babies were born vaginally and were breastfed. Hospital born babies had decreased levels of some bacteria and increased levels of other bacteria (e.g. Clostridium - with other studies finding that higher levels in children is associated with an increased risk of asthma). It was suggested that certain hospital practices may be causing this (sterile drapes, antibiotics, etc.). 

From Medical Xpress: Study shows benefits of delayed cord clamping in healthy babies

A five-minute delay in the clamping of healthy infants' umbilical cords results in increased iron stores and brain myelin in areas important for early-life functional development, a new University of Rhode Island nursing study has found. 

"When we wait five minutes to clamp the cords of healthy babies, there is a return of the infant's own blood from the placenta, and one of the results is a return of up to 50 percent of the baby's iron-rich blood cells," said URI Professor of Nursing Debra A. Erickson-Owens, a certified nurse-midwife, who conducted the study with Judith S. Mercer, also a midwife and URI nursing professor emeritus. "So when the brain needs red blood cells (and iron) to make myelin, the robustness of the iron stores make a big difference," Erickson-Owens said.

The study, published in the December issue of The Journal of Pediatrics and funded by a $2.4 million National Institutes of Health grant, challenges the practice of immediate cord clamping, which is still widespread. "I presented six times (at major conferences) on this topic last spring, and I am still concerned with the number of clinicians who do not put this evidence-based research into their day-to-day practice," Erickson-Owens said. "In fact, the American College of Obstetrics and Gynecology said in January 2017 that a one-minute delay is enough for healthy babies.

Myelin is a fatty substance in the brain that wraps around all of the axons of the nerve cells. "It's an insulator and very important in the transfer of messages across the nerve cells in the brain. It's assumed that the better the myelination, the more efficient the brain processing is," said Erickson-Owens, who helped write the American College of Nurse Midwives Statement on Delayed Cord Clamping, and assisted in writing the guidelines on cord clamping for Women & Infants Hospital.

"The regions of the brain affected by increased myelination are those associated with motor, sensory processing/function and visual development. These are all important for early-phase development," Erickson-Owens said. "The study also obtained information from checkups, blood work for iron indices, MRI scans, and neurodevelopmental testing."... Sixty-five babies remained in the study at four months.

From Medical Xpress: Babies born at home have more diverse, beneficial bacteria, study finds

Infants born at home have more diverse bacteria in their guts and feces, which may affect their developing immunity and metabolism, according to a study in Scientific Reports.

Understanding why babies born at home have more diverse microbiota for at least a month after birth, compared with those born in a hospital, could help prevent disease later in life. The human microbiome consists of trillions of bacteria, fungi and viruses that live on and in our bodies, many of which benefit our health and prevent chronic conditions such as obesity, diabetes, asthma and gut inflammatory disorders. Microbes transmitted from mother to baby help prevent chronic disease

"The reasons for the differences between infants born at home versus in hospitals are not known, but we speculate that common hospital interventions like early infant bathing and antibiotic eye prophylaxis or environmental factors—like the aseptic environment of the hospital—may be involved," said senior author Maria Gloria Dominguez-Bello, a professor in Rutgers University-New Brunswick's Department of Biochemistry and Microbiology and Department of Anthropology.

In the study, researchers followed 35 infants and their mothers for a month after birth. Fourteen infants were born at home (four of them in water) and 21 in the hospital.

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