Is it time to rethink cord management when resuscitation is needed?
A newborn who receives a placental transfusion at birth, either from cord milking or delayed cord clamping, obtains about 30% more blood volume than the newborn whose cord is cut immediately. Receiving an adequate blood volume from placental transfusion at birth may be protective for the distressed neonate as it prevents hypovolemia and can support optimal perfusion to all organs. New research shows that ventilating before clamping the umbilical cord can reduce large swings in cardiovascular function and help to stabilize the newborn. Hypovolemia, often associated with nuchal cord or shoulder dystocia, may lead to an inflammatory cascade and subsequent ischemic injury. A sudden unexpected neonatal asystole at birth may occur from severe hypovolemia. The restoration of blood volume is an important action to protect the hearts and brains of these neonates. Current protocols for resuscitation imply immediate cord clamping and the care of the newborn away from the mother's bedside. We suggest that an intrapartum care provider can achieve placental transfusion for the distressed neonate by milking the cord several times or resuscitating the neonate at the perineum with an intact cord. Milking the cord can be done quickly within the current Neonatal Resuscitation Program guidelines. Cord blood gases can be collected with delayed cord clamping. Bringing the resuscitation to the mother's bedside is a novel concept and supports an intact cord. Adopting a policy for resuscitation with an intact cord in a hospital setting will take concentrated effort and team work by obstetrics, pediatrics, midwifery, and nursing.
['Mercer|Judith S|JS|', 'Erickson-Owens|Debra A|DA|']
D001803:Blood Transfusion D003250:Constriction D036861:Delivery, Obstetric D004420:Dystocia D005260:Female D006801:Humans D020896:Hypovolemia D007231:Infant, Newborn D007234:Infant, Premature D053589:Nuchal Cord D036801:Parturition D011247:Pregnancy D011248:Pregnancy Complications D012151:Resuscitation D012782:Shoulder D013599:Systole D014470:Umbilical Cord
resuscitation placental transfusion cord milking delayed cord clamping blood volume hypovolemia perfusion asystole shock