Cord Management of the Term Newborn

Andersson, Ola; Mercer, Judith S.

doi:10.1016/j.clp.2021.05.002

Cited by 26 publications

(24 citation statements)

References 111 publications

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“…The residual placenta blood returns to the newborn warm (body temperature) and oxygenated. It contains about 15-20 mL/kg of red blood cells which provides the term infant with an adequate iron supply for four to 12 months [6,7]. There are several million to a billion stem cells providing an autologous transplant which may reduce the infant's susceptibility to both neonatal and age-related diseases [8].…”

Section: What Cord Blood Containsmentioning

confidence: 99%

“…Holding the newborn above the placenta slows transfusion, whereas lowering the newborn hastens transfusion [7,30]. However, cord clamping at 1 min with the infant on the maternal abdomen can reduce the estimated placental transfusion by 50% [31].…”

Section: Gravitymentioning

confidence: 99%

“…Anemia in infancy contributes to the global burden of morbidity and mortality during the first year of life. OCM can contribute to preventing anemia in the newborn and increased better iron storage up to 12 months of age in term infants [7]. Providers should consider that OCM is free of charge and an easy preventative measure which can be applied in any health care setting, in any gestational age and is strongly recommended by the WHO [4].…”

Section: Benefits For Term and Preterm Infantsmentioning

confidence: 99%

“…The practice of stabilization and resuscitation with an intact cord is not a new idea yet it is infrequently used in hospital settings. Midwives, in out-ofhospital settings, frequently maintain an intact cord after birth and regard the umbilical cord as a lifeline to assist in transition to neonatal life [7,56].…”

Section: Stabilization and Resuscitation With The Cord Intactmentioning

confidence: 99%

“…In the USA, the American College of Obstetricians and Gynecologists do not recommend the practice of private blood banking nor the interference of the routine practice of DCC [59]. Parents should be informed about the entire contents of cord blood and risks associated with ICC before they make a decision about banking their infant's blood [7].…”

Section: Practices That May Interfere With Placental Transfusionmentioning

confidence: 99%

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What does the evidence tell us? Revisiting optimal cord management at the time of birth

Rabe

Mercer

2022

Eur J Pediatr

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A newborn who receives a placental transfusion at birth from delayed cord clamping (DCC) obtains about 30% more blood volume than those with immediate cord clamping (ICC). Benefits for term neonates include higher hemoglobin levels, less iron deficiency in infancy, improved myelination out to 12 months, and better motor and social development at 4 years of age especially in boys. For preterm infants, benefits include less intraventricular hemorrhage, fewer gastrointestinal issues, lower transfusion requirements, and less mortality in the neonatal intensive care unit by 30%. Ventilation before clamping the umbilical cord can reduce large swings in cardiovascular function and help to stabilize the neonate. Hypovolemia, often associated with nuchal cord or shoulder dystocia, may lead to an inflammatory cascade and subsequent ischemic injury. A sudden unexpected neonatal asystole at birth may occur from severe hypovolemia. The restoration of blood volume is an important action to protect the hearts and brains of neonates. Currently, protocols for resuscitation call for ICC. However, receiving an adequate blood volume via placental transfusion may be protective for distressed neonates as it prevents hypovolemia and supports optimal perfusion to all organs. Bringing the resuscitation to the mother’s bedside is a novel concept and supports an intact umbilical cord. When one cannot wait, cord milking several times can be done quickly within the resuscitation guidelines. Cord blood gases can be collected with optimal cord management. Conclusion: Adopting a policy for resuscitation with an intact cord in a hospital setting takes a coordinated effort and requires teamwork by obstetrics, pediatrics, midwifery, and nursing. What is Known:• Placental transfusion through optimal cord management benefits morbidity and mortality of newborn infants.• The World Health Organisation has recommended placental transfusion in their guidance. What is New:• Improved understanding of transitioning to extrauterine life has been described.• Resuscitation of newborn infants whilst the umbilical cord remains intact could improve the postpartum adaptation.

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Section: What Cord Blood Containsmentioning

confidence: 99%