| Concerns about umbilical cord clamping |
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| Home -------- Site Map Apgar Oxygen an urgent ongoing need Transition fetal to postnatal circulation Tradition Protocols Outcomes >>Concerns (NCS p11) Question Authority References Links Notes Contact: Eileen Nicole Simon eileen4brainresearch@yahoo.com |
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| Evidence versus opinion |
Increased prevalence of childhood disorders |
Dependency and need for lifelong care |
Factors in need of closer examination |
References |
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| 11. Factors in need of closer examination |
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| a) Circulatory overload, polycythemia, and jaundice are current reasons for immediate clamping of the umbilical cord. However, bilirubin-staining is not uniform throughout the brain. It has long been recognized that bilirubin only enters subcortical nuclei vulnerable to ischemic damage. Ischemia causes impairment of the blood-brain barrier that prevents normally high neonatal levels of bilirubin from getting into nerve cells [77-87]; Zimmerman and Yannet pointed out in 1933, "This differs in no way from the well known fact that any intravital dye will localize in zones of injury, and will leave unstained tissues which are not damaged" [81, p757]. |
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| b) The placental fetal-maternal blood barrier should prevent fetal blood from entering the maternal circulation where antibodies to the Rh-factor can be produced by an Rh-negative mother. Dunn proposed that clamping the umbilical cord increases blood pressure within the placenta which leads to the leaking of blood [88-89]. |
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| c) As long as the umbilical cord pulsates after birth, the newborn cardiovascular system is sending a signal to the placenta for continuing oxygenation and/or blood volume from the mother. The observation of Desmond et al. made in 1959 that continuing pulsation of the umbilical stump is associated with respiratory distress remains an important body of evidence despite having become part of forgotten history [64]. |
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| d) The list of environmental worries during pregnancy, infancy, and childhood is long and includes not only fears of bilirubin, but also mercury (in fish, vaccines, and amalgam dental fillings), lead (in air and household paint), prenatal exposure to alcohol and other drugs (including anti-convulsant medications like valproic acid), |
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| Posted: February 27, 2006 (a work in progress) |
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