Curiosity. Commitment. Factfullness.
On three occasions, Hans tweeted about our research. Obviously, I was both surprised and proud that this occupied and certainly hard courted person had time to follow what we've done. Now he is deceased, lost to all of us, but especially of course for his family, friends and loved ones.
There are many who have shared their memory of Hans Rosling during the recent days, yet I cannot help but share my thoughts with you.
We are many who admire Hans and what he accomplished, from his many years of work as a doctor in Africa, his research and start-up of programs in global health and his work with Gapminder. His humanism. In all I think three words shines brightly:
Curiosity. Commitment. Factfullness.
Hans always seemed to be curious, to phenomena in the world around us, curious on people, to figure out how the earth can be better place to live. The altruistic commitment he radiated, the commitment to spread knowledge, to help people, the passion to reach out, not to gain personal benefit, but for everyone's best. And then the word that Hans is said to have coined, and he was writing a book about: factfulness. To see past our own beliefs and prejudices. The ability to see the reality that is in front of us and to base our arguments on facts and not something else.
This last has never been so important as today, when many of us so easily begin to listen to the populists and the prophets of doom, the Trumps and right extremes.
Others have written that Hans Rosling's voice was more important now than ever before. I guess what we really should say is that everyone's vote is more important than in a long time.
When similar winds as from before World War II blows cold all around us, then it is time to join Hans Rosling disciples to become apostles: Start with a good dose of humanism and add thereto Curiosity. Commitment. And perhaps above all Factfulness.
Thanks for all Hans. I will try my best to honor your memory.

Memorial fund in honor of Hans Rosling
​​​​​​​https://unicef.se/egna-insamlingar/3866-memorial-fund-in-honor-of-hans-rosling​​​​​​​

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We have published 3 papers that provide evidence why umbilical cord clamping should be delayed for 3 minutes

Photo: Kate Kennedy Photo: Kate Kennedy

In our latest study, published January 17th,
we randomized 540 children, born at a large obstetrical hospital in Kathmandu, Nepal, to early (≤ 60 seconds) or delayed cord clamping (≥180 seconds). In Nepal, approximately 70 % of infants up to one year of age have anemia. Follow-up included blood samples at 8 and 12 months of age, to evaluate anemia (hemoglobin) and iron deficiency (ferritin).
 
What did we find?
At the age of 8 months the incidence of anemia was reduced by 9% among the Nepalese infants and still at 12 months of age 8% fewer infants were anemic. The children in the delayed cord clamping group generally had higher hemoglobin values, and the percentage of children who had iron deficiency at 8 months of age decreased significantly, more than 40%.

Do you want a free Fact sheet on our latest study?

Click on the button below and sign up for our newsletter. Then you'll recieve a link for the fact sheet summorizing our findings concerning delayed cord clamping and anemia.

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A delay of umbilical cord clamping by 30 seconds at elective cesarean section results in the similar iron stores as after 3 minutes delay of cord clamping in vaginally born infants, and provides better iron stores than immediate cord clamping in vaginally born infants.
 
In November 2nd, BMJ Open published our paper: 'Elective caesarean: does delay in cord clamping for 30 s ensure sufficient iron stores at 4 months of age? A historical cohort control study'

In this study we compared iron stores at 4 and 12 months of age in infants born after elective cesarean section with their umbilical cords clamped after 30 seconds with infants born vaginally and who either had their cord clamped immediately or after 3 minutes.
 
This was actually not what we had expected. Earlier research had implied that the placental transfusion after elective cesarean was rather small and should render similar iron stores as the immediately clamped vaginally born infants. This may likely be the case if the cord also is clamped immediately after CS. What was also quite surprising was that the placental transfusion seems to happen faster after CS than after vaginally birth, as 30 seconds after CS was comparable with 3 minutes after vaginally birth. This might be explained by the fact that babies born vaginally are under a normal strain and have higher blood pressure than babies after CS.
 
The paper can be read here: Andersson O, Hellström-Westas L, Domellöf M. Elective caesarean: does delay in cord clamping for 30 s ensure sufficient iron stores at 4 months of age? A historical cohort control study. BMJ Open 2016;6:e012995. doi: 10.1136/bmjopen-2016-012995

http://dx.doi.org/10.1136/bmjopen-2016-012995

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Photo courtesy to: Kate Kennedy (https://katekennedybirthphotography.com/) Photo courtesy to: Kate Kennedy (https://katekennedybirthphotography.com/)
Yesterday, December 21st, ACOG (the American College of Obstetricians and Gynecologists) started to recommend delayed cord clamping (for at least 30-60 seconds). This is an update from their earlier opinion from 2012. As a motive from changing their recommendation for term infants, the committee cites the Cochrane review from 2013, and our study on neurodevelopment published in JAMA Pediatrics 2015. They write: “At 4 years of age, children in the early umbilical cord clamping group had modestly lower scores in social and fine motor domains compared with the delayed umbilical cord clamping group”.
Of course we are very proud to have been able to provide research that has contributed to change the practice of umbilical cord clamping on term infants in US. Still, I believe that 30-60 seconds is too short time to wait, and we will be able to show evidence on this early in 2017.
 
The committees opinon follows (cited from http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Delayed-Umbilical-Cord-Clamping-After-Birth):
Recommendations
The American College of Obstetricians and Gynecologists’ Committee on Obstetric Practice makes the following recommendations regarding the timing of umbilical cord clamping after birth:
  • In term infants, delayed umbilical cord clamping increases hemoglobin levels at birth and improves iron stores in the first several months of life, which may have a favorable effect on developmental outcomes.
  • Delayed umbilical cord clamping is associated with significant neonatal benefits in preterm infants, including improved transitional circulation, better establishment of red blood cell volume, decreased need for blood transfusion, and lower incidence of necrotizing enterocolitis and intraventricular hemorrhage.
  • Given the benefits to most newborns and concordant with other professional organizations, the American College of Obstetricians and Gynecologists now recommends a delay in umbilical cord clamping in vigorous term and preterm infants for at least 30–60 seconds after birth.
  • There is a small increase in the incidence of jaundice that requires phototherapy in term infants undergoing delayed umbilical cord clamping. Consequently, obstetrician–gynecologists and other obstetric care providers adopting delayed umbilical cord clamping in term infants should ensure that mechanisms are in place to monitor and treat neonatal jaundice.
  • Delayed umbilical cord clamping does not increase the risk of postpartum hemorrhage.
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On this date, June 17, the paper 'Effect of timing of umbilical cord clamping on iron status in Mexican infants: a randomised controlled trial' by Camila M Chaparro, Lynnette M Neufeld, Gilberto Tena Alavez, Raúl Eguia-Líz Cedillo, and Kathryn G Dewey was published in Lancet 10 years ago.
For all of us that believes that delayed cord clamping is an important subject in term newborns, this study was and is very imortant. Ten years ago, it was larger and had a longer follow-up than the earlier studies, and it was also conducted in a rigorous manner scientifically. It also contributed a lot to the conclusions of the systematic reviews that were published the following years.
They ended the paper by writing: '… delayed clamping is an invaluable opportunity to increase an infant’s iron endowment at birth, thereby ensuring adequate iron status until other interventions can be more easily implemented.'
http://dx.doi.org/10.1016/S0140-6736(06)68889-2
According to PubMed it has been cited in 262 other papers, thats some kind of achievement!

Happy anniversary!

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Yesterday I listened through a podcast on at pregnancypodcast.com about delayed cord clamping: pregnancypodcast.com/episode26/
Vanessa Merten, a mom and young professional, living in San Diego, CA, speaks in a very clear voice, has made good research and delivers a balanced information. I can really recommended it to everybody who wants to learn more about when to clamp the umbilical cord.

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Today I was interviewed by the Swedish newspaper Nerikes Allehanda. This was in conjunction with a symposia that was held during the Swedish annual spring meeting in perinatology. The symposia had speakers from the public and private stem cells banks, and me trying to explain our research findings, arguing to let the child keep it's own blood to avoid iron deficiency and improve later neurodevelopment.  http://na.se/nyheter/orebro/1.3767639-snabbtankt-och-handig-om-navelstrangen-far-sitta-kvar-ett-litet-tag

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The first private umbilical stem cell bank has recently been established in Sweden and has started discussions regarding the ethics of saving the babys blood for the future instead of letting it keep the blood for itself. Yesterday I was interviewed in Swedish television, stressing the points:
1. That the one deciliter blood that the baby loose, is equivalent to 2 liters of blood in an adult.  
2. Our research on Swedish healthy children has shown that waiting to clamp the cord for three minutes protects against iron deficiency at four months of age and improve fine motor function at four years of age.
3. Most official statements conclude, like the American College of Obstetricians and Gynecologists: "The routine storage of umbilical cord blood as “biologic insurance” against future disease is not recommended."
Here is the Swedish TV-clip: http://www.svt.se/nyheter/lokalt/vasternorrland/insamling-av-stamceller-riskerar-barns-halsa

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Photo: bigstock.com Photo: bigstock.com

My (first ever) editorial in a scientific paper was published only some days ago in Acta Pædiatrica: http://dx.doi.org/10.1111/apa.13261

I was of course thankful and honoured by the invite and quite nervous writing it :-).
The editorial is a comment on a study published at the same time by Lamberska & al: Premature infants born at less than 25 weeks of gestation may be compromised by currently recommended resuscitation techniques

In their conclusion, Lamberska et al. suggests that sustained inflation and delayed cord clamping may be effective alternatives when it comes to reducing the high mortality and morbidity among preterm infants born at the very earliest gestational ages.

Several techniques today that provides a less invasive management of the preterm transition and adaption to extra-uterine life, but they are only slowly adopted.

There's a dilemma in medicine, between providing a safe and evidence based care, and applying new approaches and techniques in a expedient way without unnecessary delay. In my own line of research, the slow adaption of delayed cord clamping is obvious, but this has been seen in many other fields, like for example transforming from resuscitation with 100 % oxygen to room air. 

The neonatal community, both regarding research and clinical work, stands before a great challenge: in not deferring the best treatment possible to our patients unnecessary long, without tampering on safety issues.

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