Effect Of Deferred Cord Clamping on Respiratory Function In Neonates delivered Preterm: Randomized Controlled Trial
AHMED ADEL HASSAN ATIA;
Abstract
Clamping the umbilical cord at birth is a human invention, and has long been the subject of controversy. It is no doubt instinctive for most obstetricians and midwives to wait for an infant's first breath before clamping the cord; until the 1980s this was explicitly stated in most textbooks of obstetrics and midwifery. Many texts also taught that the cord should not be cut until pulsations in it had ceased.
Pulsations in the cord are from the infant's heart, pumping blood to the placenta for oxygen and nutrients. Valves in the heart that direct blood flow to the placenta close after full inflation of the lungs, but this can take up to 20 minutes or more after birth.
An infant who receives a placental transfusion at birth, from delayed cord clamping, obtains about 30% more blood volume than the infant whose cord is cut immediately. Receiving an adequate blood volume from placental transfusion at birth may be protective for the distressed neonate as it prevents hypovolemia and can support optimal perfusion to all organs.
Current protocols for resuscitation imply immediate cord clamping and the care of the infant away from the mother's bedside. We suggest that an obstetrical provider can achieve placental transfusion for the distressed neonate and resuscitating the infant at the perineum with an intact cord. Neonatal Resuscitation Program guidelines. Cord blood gases can be collected with delayed cord clamping. “Bringing the resuscitation” to the mother's bedside is a novel concept and supports an intact cord. Adopting a policy for resuscitation with an intact cord in a hospital setting will take concentrated effort and team work by obstetrics, pediatrics, midwifery, and nursing.
Delaying cord clamping beyond 30 to 60 seconds after birth seems beneficial for all infants due to blood transfusion from placenta. Experimental data have demonstrated that ventilation implemented before cord clamping improved cardiovascular stability by increasing pulmonary blood flow. Healthy self-breathing neonates in a low-resource setting are more likely to die if cord clamping occurs before or immediately after onset of spontaneous respirations. The risk of death/admission decreases by 20% for every 10-second delay in clamping after breathing (Hege et al, 2014).
Perhaps someday DCC will become a national health campaign with slogans such as “spare the scissors, keep the cord,” or “cuddle, don’t cut,” or “good to the last drop: delayed cord clamping for all babies.” It wasn’t so long ago that it seemed impossible to turn the tide of elective deliveries. With sufficient dissemination of the evidence, collegial partnerships, political willpower and consumer demand, this tide can also begin to turn (Mayri, 2015).
Pulsations in the cord are from the infant's heart, pumping blood to the placenta for oxygen and nutrients. Valves in the heart that direct blood flow to the placenta close after full inflation of the lungs, but this can take up to 20 minutes or more after birth.
An infant who receives a placental transfusion at birth, from delayed cord clamping, obtains about 30% more blood volume than the infant whose cord is cut immediately. Receiving an adequate blood volume from placental transfusion at birth may be protective for the distressed neonate as it prevents hypovolemia and can support optimal perfusion to all organs.
Current protocols for resuscitation imply immediate cord clamping and the care of the infant away from the mother's bedside. We suggest that an obstetrical provider can achieve placental transfusion for the distressed neonate and resuscitating the infant at the perineum with an intact cord. Neonatal Resuscitation Program guidelines. Cord blood gases can be collected with delayed cord clamping. “Bringing the resuscitation” to the mother's bedside is a novel concept and supports an intact cord. Adopting a policy for resuscitation with an intact cord in a hospital setting will take concentrated effort and team work by obstetrics, pediatrics, midwifery, and nursing.
Delaying cord clamping beyond 30 to 60 seconds after birth seems beneficial for all infants due to blood transfusion from placenta. Experimental data have demonstrated that ventilation implemented before cord clamping improved cardiovascular stability by increasing pulmonary blood flow. Healthy self-breathing neonates in a low-resource setting are more likely to die if cord clamping occurs before or immediately after onset of spontaneous respirations. The risk of death/admission decreases by 20% for every 10-second delay in clamping after breathing (Hege et al, 2014).
Perhaps someday DCC will become a national health campaign with slogans such as “spare the scissors, keep the cord,” or “cuddle, don’t cut,” or “good to the last drop: delayed cord clamping for all babies.” It wasn’t so long ago that it seemed impossible to turn the tide of elective deliveries. With sufficient dissemination of the evidence, collegial partnerships, political willpower and consumer demand, this tide can also begin to turn (Mayri, 2015).
Other data
| Title | Effect Of Deferred Cord Clamping on Respiratory Function In Neonates delivered Preterm: Randomized Controlled Trial | Authors | AHMED ADEL HASSAN ATIA | Issue Date | 2017 |
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