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Respiratory adaptation in term infants following elective caesarean section
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  • Published on:
    Response to comments of Dr Hutchon
    • Eugene M Dempsey, Dr INFANT Research Centre, Cork University Maternity Hospital, University College Cork, Cork, Ireland
    • Other Contributors:
      • Daragh Finn, Dr

    We would like to thank Dr. Hutchon for his considered letter and for highlighting a number of important points. We very much acknowledge his experience in the area of cord management at the time of delivery and his ongoing endeavours to advocate for appropriate cord management at the time of delivery(1). He correctly notes that there is no current formal policy for cord management at delivery for term newborn infants in our institution, which undoubtedly results in variability in practice. In a recently completed prospective study evaluating cardiac output in healthy term infants, we have noted that approximately one third of infants had early cord clamping and two thirds some form of placental transfusion, either as delayed or milking. Whilst we cannot be certain or draw any definitive inferences, it is likely that this same variability exits in our cohort of patients. The point related to ‘immediate transfer’ to the resuscitaire may be somewhat misleading. This    relates to once the cord is clamped, and not that the cord was immediately clamped in each case(2).  We acknowledge that this terminology may be confusing, and therefore cannot concur that our results relate to early cord clamping alone. It is also important to highlight that all our newborns were spontaneously breathing at delivery and did not require any assistance with adaptation.

    He makes a very valid comparison with oxygen saturation values in term infants highlighti...

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    Conflict of Interest:
    None declared.
  • Published on:
    Respiratory adaptation in term infants following elective caesarean section and early cord clamping ?

    Finn et al (1) describe respiratory adaptation in term infants following elective caesarean section and the other intervention of early cord clamping(2). Although the timing of cord clamping was not documented and there is no policy for delayed cord clamping at Cork University Maternity Hospital, the authors state that the neonates were transferred immediately after birth to a Panda Resuscitator and other non-invasive monitoring equipment, thus requiring early cord clamping in all infants studied.

    The aim of the study was to define newborn physiological ventilation parameters (respiratory rate (RR), TV, end-tidal carbon dioxide (EtCO2)) over the first minutes of life in healthy-term infants following ECS, in the same way that Dawson and colleagues(3) produced centile charts in 2010 detailing the normalisation of oxygen saturations over time during newborn adaptation after normal vaginal birth. All the babies studied by Dawson et al also experienced a transition of the circulatory system which was interrupted by early cord clamping but, in a study in 2014 by Smit et al(4), in which cord clamping was delayed by at least one minute, they showed that cord clamping had resulted in a lower oxygen saturation during the first few minutes after birth. The median SpO2 of the babies experiencing early cord clamping was 11, 7 and 4% lower at minute 1, 2 and 3 respectively. All these babies already had the advantage of a physiological preparation through the mechanical and hor...

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    Conflict of Interest:
    None declared.