An interesting article From Journal of Midwifery
<http://www.medscape.com/viewpublication/870_index>  & Women's Health  MM

 

Evidence-Based Practices for the Fetal to Newborn Transition  Posted

06/22/2007

 

Van Rheenen and Brabin[31] conducted a systematic review of two randomized
controlled trials[34,36] that compared immediate versus delayed cord
clamping in term infants to determine the effect on anemia status after 2
months of age. Their secondary objective was to assess the incidence of
polycythemia and/or jaundice during the first week of life in infants who
experienced delayed cord clamping. The authors found that delayed cord
clamping, especially in anemic mothers, increased hemoglobin status and
reduced the risk of anemia at 2 to 3 months of age (RR, 0.32; 95% CI,
0.02-0.52). Although infants with delayed clamping had higher hematocrit
levels, no reports of symptomatic polycythemia or jaundice were found. The
authors stated that delaying clamping may be especially beneficial in
developing countries where anemia rates are high.

 

The current literature refutes the idea that delayed cord clamping causes
symptomatic polycythemia and indicates that immediate clamping of the cord
may often lead to anemia of infancy.

 

 

Clamping the Nuchal Cord Before Delivery of the Shoulders

 

 

In addition to anemia, possible neurologic harm from clamping a nuchal cord
before birth has been identified.[37] A recent integrated review of the
literature on nuchal cord management found reports showing increased risks
to the newborn when the cord was clamped before the shoulders are
delivered.[38] Leaving the cord intact and using the somersault maneuver is
recommended especially if shoulder dystocia is suspected. During the
somersault maneuver, the infant's head is kept near the perineum as the body
delivers so that little traction is exerted on the cord (Figure 1).[38]
Resuscitation at the perineum allows the infant to regain the blood trapped
in the placenta and can be accomplished using all the proper tenets of
neonatal resuscitation.

 

 

 <http://images.medscape.com/images/558/124/art-jmwh558124.fig1.gif> Click
to zoom

 

Figure 1.  (click image to zoom) 

 

Somersault maneuver. The somersault maneuver involves holding the infant's
head flexed and guiding it upward or sideways toward the pubic bone or
thigh, so the baby does a "somersault," ending with the infant's feet toward
the mother's knees and the head still at the perineum. 1, Once the nuchal
cord is discovered, the anterior and posterior shoulders are slowly
delivered under control without manipulating the cord. 2, As the shoulders
are delivered, the head is flexed so that the face of the baby is pushed
toward the maternal thigh. 3, The baby's head is kept next to the perineum
while the body is delivered and "somersaults" out. 4, The umbilical cord is
then unwrapped, and the usual management ensues. Figure adapted with
permission from Mercer et al.[38]

 

Cord Blood Harvesting

 

Increasing blood volume by delayed clamping should result in the infant
receiving a greater allotment of hematopoietic stem cells and red blood
cells. Hematopoietic stem cells are pluripotent, meaning that they can
develop into many different cell types.[39] Evidence suggests that
hematopoietic stem cells may migrate to and help repair damaged tissue
during inflammation and can differentiate into such cells as glia,
oligodendrocytes, and cardiomyocytes as needed.[40] In a rat model of
cerebral palsy, half the damaged rats were given human umbilical stem cells
within 24 hours of the injury. The infusion of cord blood appeared to
prevent development of the rodent version of cerebral palsy, which was
clearly evident in the damaged rats who did not get human cord blood.[41]
Yet cord blood harvesting companies advertise cord blood as "medical waste"

and encourage parents to collect it at birth. Although cord clamping time is
not prescribed in the instructions for cord blood harvesting, the suggestion
is that the earlier the cord is clamped, the larger the harvest will be.

This practice of cord blood harvesting is not supported by the American
Academy of Pediatrics unless there is a clear medical need within the
family.[42] Parents need to be fully informed by providers during pregnancy
in order to make sound decisions about storing cord blood.

 

In summary, the current literature supports a lack of harm for full term
infants when cord clamping is delayed up to 10 minutes with the newborn
placed on the maternal abdomen or held below the level of the perineum. In
addition, the evidence is strong that delayed cord clamping offers full-term
infants protection from anemia. Based on the current evidence, the
recommendation is to delay cord clamping to prevent anemia of infancy. Also,
we recommend that clinicians not cut a nuchal cord before delivery of the
shoulders, but instead, use the somersault maneuver to deliver the child and
resuscitate at the perineum as necessary.

 


             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome