LAUSR

This issue of Indian Pediatrics has published a meta-analysis on the effect of delayed cord clamping in term infants on anemia in infancy by Fu, et al. [1]. The present systematic review included 12 studies which had 993 infants in the delayed cord clamping (DCC) group and 989 infants in early cord clamping group (ECC). The review concluded that the hemoglobin and serum ferritin were significantly higher in infancy in the DCC group, compared to the ECC group. The conclusions are not different from the review by McDonald, et al. [2], which included 5 studies (620 in DCC and 532 in ECC), and concluded that infants in the late clamping group were less likely to be anemic at 3-6 months of age. However, both reviews observed high heterogeneity in the reported results, which could be due several reasons – the way iron deficiency is defined, maternal iron status, type of feeding, proportion of low birth weight babies, etc. The review by Fu, et al. [1] has added two other possible variables that could potentially contribute to the heterogeneity i.e, ethnicity and timing of delayed cord clamping. Studies that use serum ferritin alone as a measure of iron deficiency, without concomitant hemoglobin measurement, are fraught with the risk of missing iron deficiency if serum ferritin is elevated due to infection (as an inflammatory response). This could be a potential confounding, especially in lowresource settings where infection rates tend to be high. Studies observing the effect of interventions on anemia in infancy should therefore include C-reactive protein to exclude concomitant infection, along with serum ferritin and hemoglobin measurements.