Ventilation before Umbilical Cord Clamping Improves Physiological Transition at Birth or “Umbilical Cord Clamping before Ventilation is Established Destabilizes Physiological Transition at Birth”

Frontiers in Pediatrics

David J. R. Hutchon¹ 

关键词: neonatal;    preterm birth;    transition;    umbilical cord clamping;    delayed cord clamping;    resuscitation with cord intact;    intraventricular haemorrhage;   

DOI  :  10.3389/fped.2015.00029

学科分类：儿科学

来源: Frontiers

【 摘 要 】

Bhatt et al’s paper provides a good argument for ensuring that ventilation is established before clamping the umbilical cord (1). The possibility that very early clamping could explain the increased occurrence of intraventricular hemorrhage was proposed in 1988 by Hofmeyr (2) who showed that in human babies there was a marked rise in arterial pressure when the cord was clamped as late as 35 s after birth. He proposed that the sudden rise in cerebral circulation was the underlying mechanism for the higher incidence of intraventricular hemorrhage after early cord clamping (ECC) in preterm neonates. Our computer simulation of transitional circulation supports Hofmeyr’s finding (3). The simulation demonstrates that a sudden rise in cerebral pressure and blood flow is inevitable if the placental circulation is closed before the increase in pulmonary blood flow has occurred as a result of respiration. In the experimental lamb, Bhatt et al. have now provided further evidence of this adverse effect of early clamping (4). The instability in the circulation shown in their lambs may also be the result of loss of the blood volume (5) known to be redistributed from the placenta to the neonate (placental transfusion) and from the loss of the oxygenated blood from the umbilical vein. Long-term harms for the neonate may also result from loss of the stem cells capable of quickly repairing vital organ injury.

【 授权许可】

CC BY