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Re: Cord clamping/ autotransfusion (was malpractice survey)From: Tom and Elizabeth Johnston (yesallours@nc.rr.com)Sat Jun 30 15:37:45 2007
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 :
> >
> We had a baby's death in this country following "new age" birth in
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