Re: Cord clamping/ autotransfusion (was malpractice survey)
From: Bernard Cristalli (bcrist@club-internet.fr)
Sat Jun 30 16:27:31 2007
One thing is unclear: the relative positions of both the baby and the
mother and this is capital.
Bernard
Tom and Elizabeth Johnston wrote:
> I’m sorry that I haven’t replied to this earlier, but I was out of town
> presenting on this very topic all last week. My wife suggested I just leave
> this one alone, but after reading Dan and Bernard’s comments I felt I just
> had to say something. I have always been surprised that when it comes to
> the field of cord clamping physiology everyone has an opinion, but few have
> any ideas where their opinion comes from. Most folks follow the 1/3 rule
> (1/3 love it, 1/3 hate it, and 1/3 couldn’t care less), but rarely can
> anyone tell me where their opinions come from. So, to set the record
> straight and hopefully put an end to such nonsense as what we see below,
> allow me to share with you my evidence about the value of delayed cord
> clamping.
>
> -Rabe H., Reynolds G., Diaz-Rossello J. (2004) Early versus delayed
> umbilical cord clamping in preterm infants. Cochrane Database Syst Rev. 2004
> Oct 18;(4):CD003248. Review
>
> -Hutton E, Hassan, E (2007) Late Vs Early Clamping of the Umbilical Cord in
> Full-Term Neonates: A systematic Review and Meta-analysis of controlled
> trials. JAMA Vol 297 No 11.
>
> -Rheenen, P.V. & Brabin, B. (2004). Late umbilical cord-clamping as an
> intervention for reducing iron deficiency anemia in term infants in
> developing and industrialized countries: A systematic review. Annals of
> Tropical Paediatrics, 24(1), 3-16
>
> These three meta-analysis published by such well respected organizations as
> JAMA and the Cochrane database show that delayed cord clamping for 30-45
> seconds in micro premies (24-33 weeks) and 1-5 minutes (or longer) in term
> newborns, is safe and effective in preventing common complications of birth.
> These include, but are not limited to Grade III and IV intraventricular
> hemorrhage and late onset sepsis in premies. It decreases their risks of
> low blood pressure, and vascular instability as well as their needs for
> transfusions.
>
> In term infants, the benefits have not been well studied, most research has
> been on safety, but the evidence is VERY CLEAR that it is safe to delay
> clamping in term infant, and both meta-analysis on term infants have
> demonstrated a significant drop in neonatal anemia that continues up to six
> months of life. To date there have not been any studies large enough to
> adequately study respiratory distress, bowel dysfunction, or temperature
> instability, but I’m sure to see them in print in the future.
>
> So, please, before you say that cord clamping causes polycythemia,
> hyperbilirubinemia, heart failure or “bled to death”, look at the data. It
> is not possible to get too much blood from the placenta, nor is it possible
> to bleed out through the placenta. Unless, of course, the mother smokes, or
> has TTT, IUGR, GDM, CHTN, Preeclampsia, or a few other high risk conditions
> known to cause chronic hypoxia.
>
> I look forward to your comments, suggestions, or debate.
>
> Tom Johnston
>
> CNM, IBCLC
>
> To paraphrase someone (I don’t remember who);
>
> “It’s not what we know that gets us into trouble, its what we KNOW that is
> wrong, that gets us in trouble.”
>
> R. Daniel Braun a écrit :
>
>> >
>> >>Just remember that this can put some premies into heart failure.
>> >> Dan
>> >>
>> >> On 6/28/07, *Bernard Cristalli* <bcrist@club-internet.fr
>>
> _________________
>
> _________________
>
>> We had a baby's death in this country following "new age" birth in
>> these very conditions. The baby has been bled to death.
>> Bernard
>>
>
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