The Lancet, Volume 374, Issue 9687, Pages 377 - 378, 1 August 2009
Could early cord clamping harm neonatal stabilisation?
Judith Mercer, Susan Bewley
David Odd and colleagues (May 9, p 1615)1 show that mild perinatal insults, as evidenced by the need for resuscitation, could precede cognitive impairment in children at 8 years. Could early cord clamping be a potential iatrogenic cause of both the need for resuscitation and later outcome?
The placenta does not stop working just because the infant is outside the uterus. It continues to provide gas exchange during the early minutes at physiological transition. Current service provision dictates immediate cord clamping when infants need resuscitation. Yet as long ago as the 1960s, Yao and others2 showed that immediate cord clamping results in a 30% lower blood volume and up to a 50% lower red-cell volume for the newborn infant. It is possible that this deficiency could predispose neonates to ischaemic damage.
Such damage might begin with an inflammatory cascade resulting from the hypoxia due to loss of blood volume and components.3 Meier and colleagues4 showed that human umbilical stem cells injected into the abdomens of 7-day-old rats within 24 h of a laboratory-induced brain injury prevented ******* paresis, suggesting a timely reparative role when there is an insult. In a series of MRIs in infants with hypoxic-ischaemic encephalopathy, Cowan and colleagues5 showed little or no indication of damage on the first day, gradually progressing to severe damage by the end of the first week. In infants who do not progress to severe damage, subtle early effects of hypoxia-ischaemia due to blood loss could induce some level of injury which might not be detectable.
We propose that cord clamping is documented for all births, especially in research studies. Otherwise we will never fully understand the effect of interventions in physiological fetal-to-neonatal transition and how to ensure that resuscitation practices cause no harm.
We declare that we have no conflicts of interest.
References
1 Odd DE. Resuscitation at birth and cognition at 8 years of age: a cohort study. Lancet 2009; 373: 7. Full Text | PDF(244KB) | CrossRef | PubMed
2 Yao AC, Moinian M, Lind J. Distribution of blood between infant and placenta after birth. Lancet 1969; 2: 871-873. PubMed
3 Rajnik M, Salkowski CA, Thomas KE, Li YY, Rollwagen FM, Vogel SN. Induction of early inflammatory gene expression in a murine model of nonresuscitated, fixed-volume hemorrhage. Shock 2002; 17: 322-328. CrossRef | PubMed
4 Meier C, Middelanis J, Wasielewski B, et al. ******* paresis after perinatal brain damage in rats is reduced by human cord blood mononuclear cells. Pediatr Res 2006; 59: 244-249. CrossRef | PubMed
5 Cowan F, Rutherford M, Groenendaal F, et al. Origin and timing of brain lesions in term infants with neonatal encephalopathy. Lancet 2003; 361: 736-742. Summary | Full Text | PDF(100KB) | CrossRef | PubMed
a bit, as it's like "not guilty until proven!" 
) and since there has been no cause for swabbing at any point i haven't had one done and i haven't requested one.
at the timing but good luck, hope the appointment goes well 
the ones i do have are awful as i was being rushed to get into a ambulance and it was so fast i didnt get any pool shots
