Rapid Responses to:
|
|
Rapid Responses: Rapid Responses published:
-
![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Lost Causes and Side Effects
- George Malcolm Morley (17 December 2001)
-
Allocation of placebo cannot be justified for iron deficiency anaemia.
- Martin D Tobin (21 December 2001)
-
Anemia, Jaundiced, caused by inadequate training of birth medical persons.
- Donna Young (13 July 2003)
|
|
|||
|
George Malcolm Morley, Retired obstetrician/gynecologist PO Box 181, Northport, MI 49670 USA
Send response to journal:
|
Stoltzfus et al. add more evidence to the association of infant anemia with neurological impairment, however, the improvement in language/motor disability with iron therapy in this study contrasts with other studies which show no resolution of grade school neurological defects with iron therapy in infancy. This difference may be explained by differing causes of the anemia and, consequently, different primary causes of the neurological defects. Neonatal asphyxia (hypoxia) for as short a time as six minutes causes permanent neurological damage - death of neurons; loss of brain tissue has been demonstrated in asphyxiated newborn primates and correlated with memory dysfunction and spastic paralysis.[1] At normal birth, continuous brain oxygenation is supplied from the placenta until the lungs are oxygenating the brain, at which time the cord vessels close reflexively. During this interval, the placental transfusion supplies additional blood volume for adequate perfusion of the pulmonary vessels and gaseous exchange.[2][3] This duplicate placental/pulmonary oxygenation precludes hypoxic brain damage and adequate blood volume prevents ischemic brain damage. Immediate cord clamping, as promoted by the American College of Obstetricians and Gynecologists[4] and as demanded by resuscitation neonatologists, produces immediate neonatal asphyxia until the lungs function; it also prevents placental transfusion, thus delaying adequate pulmonary perfusion and pulmonary respiration.[2][3] If the consequent asphyxia is not reversed within six minutes, brain damage will occur and progress. The immediately clamped newborn, deprived of up to 50% of its normal blood volume, is also doomed to develop infant iron deficiency anemia.[5] The child which is delivered without the use of a cord clamp receives a full placental transfusion with enough iron to prevent anemia for the first year of life;[5] newborn hemoglobin levels are high regardless of the iron status of the mother. Such a child would appear to be immune to neurological defects "caused" by anemia. Hurtado correlated the degree of grade school mental deficieny with the degree of infant anemia.[6] Thus neurological defects of hypoxic, ischemic origin share a common cause with infant anemia - premature clamping of the umbilical cord at birth. Anemia is NOT the primary cause of the neurological defect, but a coincidental effect of hypovolemia induced by immediate cord clamping. The hypoxic, ischemic brain lesions will not improve with treatment of anemia. One can only speculate on the cord clamping status of the babies in Stolfus' study. If they had western pediatric care, many may have had western obstetrical care and may have lost much of the normal placental transfusion. However, in many "primitive" births, the mother or midwife severs the cord (without tying or clamping) after delivery of the placenta, long after the natural placental transfusion is complete. If this occurred, these neonates would not be anemic, hypovolemic or asphyxiated, the anemia must have developed gradually after birth (? from infestations) and the language/motor defects and their subsequent improvement may indicate neurological impairment caused by anemia and reversible by correction of anemia. It is interesting to note that Windle noted remarkable "recovery" or adaptation to hypoxic brain injuries which were very apparent at subsequent autopsy.[1] Physiological cord closure (placental transfusion) produces a physiological blood volume optimal for survival, and a healthy, normal baby. It does not routinely cause pathological jaundice, hypervolmia, hyperviscosity, polycythemia or plethora; if it did, Man would be extinct. Immediate cord clamping[4] is universally condemned in the literature. It causes loss of placental oxygenation and lack of blood volume; the consequnt hypoxic, ischemic encephalopathy may cause neonatal death[7] or spastic paralysis, or it may be so mild as to cause behavioural defects which only become apparent in grade school. The associated infant anemia[6] is only a refection of how much of the infant's blood volume was left clamped in its placenta.[8] The cord clamp is a very dangerous instrument.[2][3] References: [1] Windle, WF "Brain Damage by Asphyxia at Birth". Scientific American 1969 Oct; 221(4):76-84. [2] Morley GM., Cord Closure: Can Hasty Clamping Injure the Newborn?" OBG MANAGEMENT July 1998, 29-36. [3] Morley GM. Letters. OBSTETRICS & GYNECOLOGY, Vol 97. No.6 June 2001 1024-1026 [4] ACOG; 1995 Umbilical Artery Blood Acid-Base Analysis. Educational Bulletin 216. [5] Linderkamp O. Placental Transfusion: Determinants and Effects. Clinics in Perinatology 1982; 9: 559-592 [6] Hurtado EK et al. Early childhood anemia and mild to moderate mental retardation. Am J Clin Nutr. 1999; 69(1): 115-119 [7] Peltonen T. Placental transfusion - Advantage and Disadvantage. Euro. Journal of Paediatrics, 1981; 137: 141-146 [8]Erasmus Darwin, Zoonomia 101: "Another thing very injurious to the child, is the tying and cutting of the navel-string too soon; which should always be left till the child has not only repeatedly breathed but till all pulsation in the cord ceases. As otherwise the child is much weaker than it ought to be, a part of the blood being left in the placenta, which ought to have been in the child." G. M. Morley, MB ChB (Ed.) FACOG |
|||
|
|
|||
|
Martin D Tobin, MRC Clinical Research Fellow Department of Epidemiology and Public Health, University of Leicester, Leicester LE1 6TP
Send response to journal:
|
EDITOR - I was concerned by the study design adopted by Stoltzfus et al to assess the effects of oral iron supplements in children in Pemba Island, Zanzibar (1). Before this study, there was ample evidence that iron-deficiency anaemia was ubiquitous in this community and that oral iron was effective for treating such anaemia. Allocation of placebo therefore cannot be justified, even by their use of additional outcome measures or by medical intervention for children only with the most severe anaemia. Furthermore, Stoltzfus et al found that oral iron had little impact on haemoglobin concentration (1). A plausible explanation is that the treatment effects were diluted due to the sharing of the allocated preparations with other community members perceived to be anaemic. The knowledge that 50% of preparations would be inactive would not be sufficient deterrent to circumvent this problem. In Zanzibar, surveys have shown anaemia to be prevalent across all age groups. For example, 79% of pregnant women in urban Zanzibar had haemoglobin concentrations of <10 g/dl (2), and in rural Pemba, haemoglobin concentrations were <8.7 g/dl in 54% of women attending routine antenatal clinics (3). In July 1995, I carried out a survey among 258 working males aged 17-60 in rural Pemba. Their mean haemoglobin concentration was 11.1 g/dl; 25% had haemoglobin <10 g/dl and only 11% reached the concentration required for blood donation (13.5 g/dl). Sharing of medicines is commonplace in Pemba. This was particularly likely to be the case for iron supplements, which met only a fraction of the need in primary health care units at the time the study took place, and which most of the population can ill-afford from private dispensaries. This would bias treatment effects towards the null. It is important that policy-makers do not take the wrong message from the authors’ comment that there are severely anaemic children not recognised by the healthcare system (1). From my own observations in Pemba, and those of studies in similar settings (4), the capacity of primary health care workers to diagnose anaemia far outstrips available resources to treat it. Iron supplementation should be widely accessible in areas where malaria is endemic and anaemia almost universal. Yet we have not achieved this most basic of steps. Tackling this issue and the underlying causes of anaemia will require not only rigorous basic science and health services research, but also a long-term commitment of resources by governments and non-governmental organisations. Declaration of Interest: I worked as a medical officer and trainer in Micheweni district, Pemba Island for the Ministry of Health and Action Health, August 1994 – August 1995. Action Health has since joined with Skillshare International, Leicester, UK. http://www.skillshare.org/ The above represents my own views and not necessarily those of the organisation. 1. Stoltzfus RJ, Kvalsvig JD, Chwaya HM, Montresor A, Albonico M, Tielsch JM, Savioli L, Pollitt E. Effects of iron supplementation and anthelmintic treatment on motor and language development of preschool children in Zanzibar: double blind, placebo controlled study. BMJ 2001; 323: 1389-1393. 2. Matteelli A, Donato F, Shein A, Muchi JA, Leopardi O, Astori L, Carosi G. Malaria and anaemia in pregnant women in urban Zanzibar, Tanzania. Annals of Tropical Medicine & Parasitology 1994; 88(5): 475- 83. 3. Dorman EK, Shulman CE. Micheweni Hospital Report to Action Health, May 1990 – August 1991. Cambridge: Action Health (now Skillshare International), 1991. 4. Shulman CE, Levene M, Morison L, Dorman E, Peshnu N, Marsh K. Screening for severe anaemia in pregnancy in Kenya, using pallor examination and self-reported morbidity. Transactions of the Royal Society of Tropical Medicine & Hygiene 2001; 95(3): 250-5. |
|||
|
|
|||
|
Donna Young, www.lotusbirth.com V1G 4H4
Send response to journal:
|
I found this research interesting, on anemia. But it is lacking in the cause of anemia and even jaundice in babies, leading likely to impairment of the newborn child, from subtle to serious. The current trend of doctors is to do hasty umbilical cord clamping. It causes anemia and jaundice. Generally, this hasty clamping follows the use of the muscle-contracting snythethic drug, oxytocin, pitocin, syntocinon, Toesen. These drugs (sometimes combined with morphine) cause the mother to experience hard, long labor, close together, and the child is deprived oxygen. The morphine numbs her brain so she is none-the- wiser, sometimes. Consequently, following hasty clamping, the child has more dead blood cells in his/her body. The iron and protein from these excessive killing off of red cells, creates the appearance of jaundice, the yellow pigmentation of the iron overloaded in the child's system, my theory on this. While the child may be thought as having more red cells in his body, for iron indication of jaundice, the fact is the opposite. The child is low-volumed blood and pressure, likely now having a hole in the heart and brain lesions. The child is really anemic, lacking too few red blood cells and other nutrients and components of blood. This is because the umbilical cord was hastily clamped and the blood trapped in the placenta was taken, without informed consent, and sent, sold, or donated to cord stem cell research. This is harvesting the baby for the trend of science research, particularly in stem cells. The amount of blood deprived the baby is from 4 to 6 ounces of blood or 20 to 50 percent total blood volume. A 9-pound baby takes 9-months of gestation to produce 10 ounces of blood, and if the child is deprived 1/2 that is cruel and unusual punishment I am surprised medical experts have not recognised this as battery and assault, stated in the criminal codes, world wide I'm sure. To make a false medical policy, to direct others or teach them to endanger a child is likely under common nusiance, at least it is in Canada, Section 180. Some children have actually died of shock by even as little as 20 percent deprivation of their placenta blood, and some were seriously impaired. (Chow-case-law, Sommers and Roth, Ontario, Canada). The Society of Obstetricians and Gynecologists of Canada (SOGC) know the baby deprived of the said blood volume by hasty clamping, result in the baby to be weaker from 6 weeks to 6 months. Yet, they still approved a policy #89 May 2000, to direct routinely immediate cord clamping on all babies. This followed the known endangering of the babies in their Policy #71, December 1998. We are seeing professional silence, world wide, as 'no' professional or politician is requesting an Official Commission Inquiry to protect the vulneravle child. We even have a violation to the faith of some who if they knew what was going on their baby's placenta and blood used in human transplants, would find that against their faith, and a breach of trust, to not have burned the blood, but in discarding, used it without informed consent in human blood products. If you wish to write me a letter advocating this is necessary, to have an Official Commissioned Inquiry, even by International Court Inquiry, please do, my address is: Box 504 Dawson Creek, BC, V1G 4H4 Canada, Donna Young, mother and grandmother, and a researcher on Umbilical cord clamping of the child. Donations are greatly accepted, to keep my web site going at: www.lotusbirth.com This information of endnagering babies, as to statements of Dr. George M. Morley, a retired O & G, has long been known, so I am shocked why medical doctors and nurses and midwives are amazed when I bring it to their attention, as a lay person. My resources of World Book, Edition 1979, revealed much of the information on the child's blood, so if any encyclopedia had the same information and Dr. Erasmus Darwin was saying this back in 1801, what good excuse do the present trainers of medical persons have today? And, for making policies outside of observable facts of science and outside of empirical medicine, as well. Lets hope for improvement in bringing to the public's attention all false training and policies and that means to correct the first cause of misinformation, and that is in the Biology textbooks. I advocate for signed birth contracts that mothers are informed no clamping or cutting of the cord is necessary, it is only done for cosmetic reasons, unless the cord tore or for placenta previa. I give complete references of my research at my web site. Sincerely, Donna Young dyoung@pris.ca Competing interests: None declared |
|||