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Deferred cord clamping and polythene bags at delivery: measuring and improving quality
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  • Published on:
    Delayed cord clamping saves lives – why does it not affect major complications?
    • Judith S Mercer, Professor Emerita in Midwifery University of Rhode Island
    • Other Contributors:
      • Heike Rabe, Professor of Perinatal Medicine

    We thank Pettinger et al for their excellent editorial and for offering an intriguing question – why does delayed cord clamping (DCC) not appear to affect major complications? (Pettinger 2024) We offer three answers. First, many of the surviving infants may have died without DCC. Second, we don’t wait for the neonate to obtain enough of its own blood to survive and thrive. Third, during the 30-60 seconds, practices we use stress the infant which may impede the placental transfusion.
    First, many of the surviving infants may have died without a brief delay in cord clamping (30-60 seconds). They may have received enough additional blood to survive, but not to thrive. The survivors will have co-morbidities of prematurity. Cord blood contains many stem cells, red blood cells with fetal hemoglobin, plasma, progesterone, and other messengers as well as providing enhanced perfusion. Enhanced prefusion delivers mechanical stimuli which causes electrochemical signaling to stimulate the endothelial cells (ECs) to secrete tissue specific angiocrine/paracrine growth factors essential for normal function, maturation, maintenance, and repair of all organs [1,2]. ICC and ECC reduce potential blood volume (equivalent to a class 2 or 3 hemorrhage in adults) to the infant thereby contributing to loss of organ specific vascular competence in the GI tract, brain, kidneys, and other organs potentially exacerbating the common problems seen in the NICU.[3]
    At birth, we don’t know ho...

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    Conflict of Interest:
    None declared.