Historical perspectives on umbilical cord clamping and neonatal transition

Downey, Candice; Bewley, Susan

doi:10.1258/jrsm.2012.110316

Cited by 46 publications

(29 citation statements)

References 16 publications

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“…This was already practised by Darwin [34 ]in 1801. Waiting until the pulsations have ceased has become an axiom in obstetrics, recommended by Magennis and Apgar, cited by Downey [35] and Leboyer [36] and referred to in a great variety of textbooks, but no studies based on evidence have actually been found [37]. It has been taught to Dutch midwives for decades [38] and is also standard practice in the USA [39,40].…”

Section: Discussionmentioning

confidence: 99%

Current Practice of Cord Clamping in The Netherlands: A Questionnaire Study

Boere¹,

Smit²,

Roest³

et al. 2014

Neonatology

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Background: Recent meta-analyses recommend delayed cord clamping (DCC) after uncomplicated births as well as preterm births, but there is no clear definition of timing and uniform national guidelines are lacking. Objective: We aimed to investigate if guidelines for the timing of cord clamping (CC) are followed and what the national practice entails. Methods: A postal questionnaire concerning CC after uncomplicated vaginal, Caesarean term and preterm deliveries was sent to all midwifery practices (n = 526) and obstetrical departments (n = 94) in the Netherlands. Results: The response rate was 81% (500/620). CC protocols were present in 16 and 38% of midwifery and obstetric practices, respectively. Early cord clamping (ECC) was recommended in 54%, DCC in 33%, 6% indicated a specific time point and 7% did not specify. In current practice, DCC was applied after uncomplicated vaginal term deliveries in 90% and ECC in 6%, and no timing was specified in 4%. Midwives used DCC more often than obstetricians (97 vs. 75%). Cessation of cord pulsations was often (54%) used as a time point, 40% used a fixed time point, 2% waited for placental expulsion and 4% did not specify. ECC was preferred in obstetric practices after Caesarean deliveries (in 81%). In preterm births, ECC was practised by 36%, DCC by 54 and 10% did not specify. Conclusion: In the Netherlands, although often not protocolized, DCC is widely used after uncomplicated vaginal term and preterm deliveries, but not after Caesareans. Cessation of cord pulsation is often used as the time point for CC.

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Section: Discussionmentioning

confidence: 99%

Current Practice of Cord Clamping in The Netherlands: A Questionnaire Study

Boere¹,

Smit²,

Roest³

et al. 2014

Neonatology

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“…Over several centuries, this practice has morphed into one where immediate cord clamping has become standard practice. It has been suggested that immediate cord clamping was adopted as a consequence of developing a medical cord clamp, theories about preventing erythroblastosis fetalis and about placental blood as a new source of transfusion blood, and introducing the Apgar score [9]. This practice of immediate cord clamping became standard practice without any studies showing it was more beneficial than the previous practice of delayed cord clamping.…”

Section: Rbc Transfusionmentioning

confidence: 99%

Evidence-Based Advances in Transfusion Practice in Neonatal Intensive Care Units

2014

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Background: Transfusions to neonates convey both benefits and risks, and evidence is needed to guide wise use. Such evidence is accumulating, but more information is needed to generate sound evidence-based practices. Objective: We sought to analyze published information on nine aspects of transfusion practice in neonatal intensive care units. Methods: We assigned ‘categories of evidence' and ‘recommendations' using the format of the United States Preventive Services Task Force of the Agency for Healthcare Research and Quality. Results: The nine practices studied were: (1) delayed clamping or milking of the umbilical cord at preterm delivery - recommended, high/substantial A; (2) drawing the initial blood tests from cord/placental blood from very low birth weight (VLBW, <1,500 g) infants at delivery - recommended, moderate/moderate B; (3) limiting phlebotomy losses of VLBW infants - recommended, moderate/substantial B; (4) selected use of erythropoiesis-stimulating agents to prevent transfusions - recommended, moderate/moderate-moderate/small B, C; (5) using platelet mass, rather than platelet count, in platelet transfusion decisions - recommended, moderate/small C; (6) permitting the platelet count to fall to <20,000/µl in ‘stable' neonates before transfusing platelets - recommended, low/small I; (8) permitting the platelet count to fall to <50,000/µl in ‘unstable' neonates before transfusing platelets - recommended, moderate/small C, and (9) not performing routine coagulation test screening on every VLBW infant - recommended, moderate/small C. Conclusions: We view these recommendations as dynamic, to be revised as additional evidence becomes available. We predict this list will expand as new studies provide more information to guide best transfusion practices.

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“…1 For term births, timing of cord clamping does not have a clear effect on postpartum blood loss. However, immediate clamping reduces neonatal haemoglobin and neonatal jaundice.…”

Section: Introductionmentioning

confidence: 99%

Innovation in immediate neonatal care: development of the Bedside Assessment, Stabilisation and Initial Cardiorespiratory Support (BASICS) trolley

et al. 2015

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ObjectiveBabies receive oxygen through their umbilical cord while in the uterus and for a few minutes after birth. Currently, if the baby is not breathing well at birth, the cord is cut so as to transfer the newborn to a resuscitation unit. We sought to develop a mobile resuscitation trolley on which newly born babies can be resuscitated while still receiving oxygenated blood and the ‘placental transfusion’ through the umbilical cord. This would also prevent separation of the mother and baby in the first minutes after birth.DesignMultidisciplinary iterative product development.SettingClinical Engineering Department of a University Teaching Hospital.MethodsFollowing an initial design meeting, a series of prototypes were developed. At each stage, the prototype was reviewed by a team of experts in the laboratory and in the hospital delivery suite to determine ease of use and fitness for purpose. A commercial company was identified to collaborate on the trolley's development and secure marking with the Conformité Européenne mark, allowing the trolley to be introduced into clinical practice.ResultsThe trolley is a small mobile resuscitation unit based on the concept of an overbed hospital table. It can be manoeuvred to within 50 cm of the mother's pelvis so that the umbilical cord can remain intact during resuscitation, irrespective of whether the baby is born naturally, by instrumental delivery or by caesarean section. Warmth for the newborn comes from a heated mattress and the trolley has the facility to provide suction, oxygen and air.ConclusionsThis is the first mobile resuscitation device designed specifically to facilitate newborn resuscitation at the bedside and with an intact cord. The next step is to assess its safety, its acceptability to clinicians and parents, and to determine whether it allows resuscitation with an intact cord.

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Historical perspectives on umbilical cord clamping and neonatal transition

Cited by 46 publications

References 16 publications

Current Practice of Cord Clamping in The Netherlands: A Questionnaire Study

Current Practice of Cord Clamping in The Netherlands: A Questionnaire Study

Evidence-Based Advances in Transfusion Practice in Neonatal Intensive Care Units

Innovation in immediate neonatal care: development of the Bedside Assessment, Stabilisation and Initial Cardiorespiratory Support (BASICS) trolley

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