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Studies of fetal to neonatal transition
Interventions during transition may be completed before the infant reaches the neonatal unit but they have the potential to influence the rest of the infant's life. We publish three articles in this subject area. The editor's choice is the review article by Stuart Hooper and colleagues which summarises advances in knowledge regarding the physiological effects of umbilical cord clamping at birth. It is already widely recommended that there should be a period of delay after delivery before the umbilical cord is clamped and it is well recognised that this provides additional blood volume that impacts on later haemodynamic stability and the risk of anaemia. This article focuses on the startling haemodynamic disturbances that result from completely obstructing the placental circulation before an infant has started to breathe. The effect is to cause marked swings in cardiac output, blood pressure and oxygenation that are largely avoided when cord clamping is delayed until after breathing is established. It is really worth going through this article carefully to gain understanding of the physiological changes that have been demonstrated in controlled animal studies. The importance of outcome studies in human preterm infants of stabilisation after …
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