2015 > 05

I was interviewed by Swedish Radio P4 Halland. This interview covers a lot of what has happend in the study.

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So grateful for his continuous attention and support.

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JAMA Pediatrics published our latest study results today. We will return with more info, but some you can find under MEDIA. A short fact sheet is possible to download.
In this video clip on Youtube you will find a summary of the results: 

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Both recently, Farrar & al in BJOG. 2011 Jan;118(1):70-5, report in their results: ”Placental transfusion was usually complete by 2 minutes, but sometimes continued for up to 5 minutes.”

This is perfectly in line with the old classic study by Yao AC, Moinian M, Lind J. in Lancet. 1969 Oct 25;2(7626):871-3, “Distribution of blood between infant and placenta after birth” where “the corrected blood-volume of infant” rose with additional 8.3 ml/kg from 2 to 3 minutes (from 84.5 ml/kg to 92.8 ml/kg)

Farrah & al reported that placental transfusion contributed with 32 ml (95% CI, 30-33 ml) per kilogram of birth weight to blood volume, but 24 ml (95% CI, 19-32 ml) based on inspection.” and “The mean difference in weight was 116 g [95% confidence interval (CI), 72-160 g] using the B-spline and 87 g (95% CI, 64-110 g) using inspection”

In contrast Vain & al, in Lancet. 2014 Jul 19;384(9939):235-40, “Effect of gravity on volume of placental transfusion: a multicentre, randomised, non-inferiority trial” did only 2 minutes cord clamping and demonstrated a mean weight change of 56 g in the introitus group compared with 53 g in the abdomen group (I am surprised that reviewers did not comment this rather low weight gain, implicating a possible incomplete placental transfusion)

In our own RCT; Andersson & al, BMJ. 2011 Nov 15;343:d7157 “Effect of delayed versus early umbilical cord clamping on neonatal outcomes and iron status at 4 months: a randomised controlled trial” the weight difference between early (less than 10 sec) and delayed (180 sec or more) newborns was 96 g or 26 g/kg implying a placental transfusion of about 90 ml. 

My concern is that by referring to the Vain study (as well as the Chaparro study in Lancet 2006 where DCC also was 2 min) there is a risk that a lot of newborns will be “intermediately clamped” and will not receive the optimal placental transfusion. 

Most likely, you should wait until the umbilical cord goes from blue and thick til it's white and thin. You can find photos illustrating this here: www.nurturingheartsbirthservices.com

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Keith J. Barrington is a neonatologist and clinical researcher at Sainte Justine University Health Center in Montréal. He writes one of the most active and informative blogs on neoanatal research : http://neonatalresearch.org

Last week, on May 18th and 19th he wrote two posts on the most recent research on preterms and umbilical cord clamping/milking. In addition to the very good short descriptions of the studies, he also write these insightful sentences:

"There is a lot going on in this field right now, so its difficult to stay up with everything, at the PAS-meeting this year there were many studies, ancillary studies and physiologic investigations that were relevant. I haven’t had time to digest them all.

One important factor to consider is that the physiologic benefits demonstrated, in animal models, of delaying cord clamping are not due solely (or even mostly) to transfusion effects. Cardiovascular adaptation around birth is different when the cord is clamped after the onset of breathing, I am not sure if there is a similar study of the effects of cord milking, but I would guess that the effects would be quite different. I don’t think we should assume that the two procedures are equivalent, even if the same amount of extra blood is delivered."

Please read here:
Delayed cord clamping or cord milking for the very preterm newborn… or both?

Below he goes through the abstracts from PAS to find those that had new information, from controlled trials, about the efficacy and safety of cord milking and/or delayed clamping.
Cord milking/delayed clamping at the 2015 PAS-meeting

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The last day has been used for preparing the publication of our four year follow up paper on Tuesday May 26th. Talking and writing to journalists.

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Tags: blog, diary

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Today, cordclamping.org starts to take its first steps as a web page for people interested in umbilical cord clamping. 

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Tags: blog


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