A Comparative Study of a Structured Nurse-Parent Education Program on Neonatal Iron Status and Adherence to Delayed Cord Clamping Guidelines
Article Sidebar
Main Article Content
Abstract
Background: Delayed cord clamping improves neonatal iron reserves through continued placental transfusion, yet adherence to recommended timing remains inconsistent in routine maternity care. Nurse-led parental education may improve implementation of evidence-based cord clamping practices and support better neonatal hematological outcomes. Objective: To compare the effect of a structured nurse–parent education program with routine maternity counseling on adherence to delayed cord clamping guidelines and neonatal iron status at 6–8 weeks postpartum. Methods: A parallel-group randomized controlled trial was conducted in tertiary-care hospitals of Central Punjab, Pakistan, from August 2025 to February 2026. Eighty-four mother–newborn dyads were randomized equally into intervention and control groups. The intervention group received structured nurse-led education regarding neonatal iron physiology and delayed cord clamping, while controls received routine counseling. Complete-case analysis included 77 dyads. Outcomes included neonatal serum ferritin, hemoglobin concentration, and adherence to delayed cord clamping at or beyond 60 seconds. Results: Neonates in the intervention group had higher serum ferritin than controls at 6–8 weeks (132.6 ± 21.4 vs 113.7 ± 19.6 ng/mL; mean difference 18.9 ng/mL; p<0.001) and higher hemoglobin concentration (13.8 ± 1.1 vs 12.7 ± 1.0 g/dL; mean difference 1.1 g/dL; p<0.001). Delayed cord clamping adherence was also greater in the intervention group (89.7% vs 57.9%; p=0.002). Conclusion: Structured nurse–parent education improved adherence to delayed cord clamping recommendations and was associated with better neonatal iron status during early infancy.
Article Details
Issue
Section
This work is licensed under a Creative Commons Attribution 4.0 International License.
How to Cite
References
1. Kirkland KA. Best practices in family centered care in the neonatal intensive care unit. 2022.
2. Karunarathna I. Comprehensive neonatal care: clinical evaluation, early interventions. 2022.
3. Williams TC. Family centered care in the neonatal intensive care unit: a standard checklist for nurses and parents. 2022.
4. Oates BC, Stewart CS, Ranck MS. Poster abstracts presented at the Fall 2022 National Neonatal, Advanced Practice, and Mother Baby Nurses Conferences. 2022.
5. Sundararajan V, Patil MP, Kaur S, Gautam MS, Bharathi ES. Textbook of high-risk newborn. Xoffencer International Book Publication House; 2025.
6. Ricci S. Essentials of maternity, newborn, and women’s health nursing. Philadelphia: Lippincott Williams & Wilkins; 2024.
7. Giles A, Prusinski R, Wallace L. Maternal-newborn nursing. OpenStax; 2024.
8. Brown CS. Improving a neonatal care process to enhance the prognosis of the neonate. Barry University; 2024.
9. Sk MH, Saha B, Saha AK. Impact of a quality improvement initiative on neonatal stabilization and admission patterns in a special care newborn unit in India. J Neonatal Perinatal Med. 2025;19345798251387331.
10. Neonate HR. Golden hour and thermoregulation. Principles of Neonatology. 2023;10:57.
11. Schofield EE, Winter LW. Golden hour and thermoregulation. In: Principles of neonatology. Elsevier; 2024. p. 57-61.
12. Situmorang HE, Rustina Y, Novieastari E. Understanding cultural barriers to the care of low-birth-weight infants in Papua, Indonesia: a qualitative descriptive study. Belitung Nurs J. 2025;11(5):579.
13. Phillips RJ. Neuroprotective care of extremely preterm infants in the first 72 hours after birth. 2022;5:9.
14. World Health Organization. Kangaroo mother care: implementation strategy for scale-up adaptable to different country contexts. Geneva: World Health Organization; 2023.
15. Al-Dewik N, Abuarja T, Younes S, Nasrallah G, Alsharshani M, Ibrahim FE, et al. Precision medicine activities and opportunities for shaping maternal and neonatal health in Qatar. 2024;21(5):313-33.
16. Zamana TVHAM, Millerb SP, Bhuttaa ZA. Nutrition, brain development, and mental health. 2022:122.
17. Cleary JJ. Abstracts from the California Association of Neonatologists Cool Topics in Neonatology 27th Annual Conference. Neonatology Today. 2022;17(2).
18. White R, Brown J, Smith V, Chao HS, Goldstein MJ. Gravens by Design: selected abstracts from the 38th Annual Gravens Conference on the Environment of Care for High-Risk Infants and Their Families. Neonatology Today. 2025;20(9).
19. Poh P, Carey M, Lee JH, Manning JC, Latour J. Impact of ethnicity on parental health outcomes after childhood critical illness: a mixed-methods systematic review. 2022.
20. Nangia S. Management of hypoxia. In: IAP Neonatology Textbook of Neonatal Resuscitation. 2023. p. 157.