Letters

Neonatal prevention of iron deficiency

BMJ 1996; 312 doi: https://doi.org/10.1136/bmj.312.7038.1102d (Published 27 April 1996) Cite this as: BMJ 1996;312:1102

Blood can be transfused from cord clamped at placental end

  1. D G Daniel,
  2. A N A Weerakkody
  1. Consultant obstetrician Consultant obstetrician Royal Gwent Hospital, Newport, Gwent NP9 2UB

    EDITOR,—Alfredo Pisacane advocates placental transfusion to increase iron stores in neonates.1 This is easy at vaginal delivery but difficult and potentially hazardous at caesarean section. We would suggest clamping of the placental end of the cord as an alternative (DGD and ANAW, 27th British congress in obstetrics and gynaecology, Dublin, 1995), especially in premature infants, who will benefit from an increase in haemopoietic stem cells2 as well as the iron. The problems with placental transfusion at caesarean section are those of possible delayed resuscitation, hypothermia, and displacement of the surgeon or assistant. Alternatively, if the placenta is delivered immediately with the infant without the cord being clamped the risks are maternal haemorrhage and air embolism and neonatal haemorrhage from torn placental vessels.

    A study of the cords in 120 mature infants delivered by caesarean section suggests that clamping the cord at the placental end and holding it above the infant during resuscitation results, on average, in a neonatal transfusion of 41 ml (fig 1). “Full cords” were clamped at both ends within 10 seconds of delivery, “drained cords” were the same cords after passive draining into a sink, and “transfused cords” had drained passively into the infant for three minutes. Figure 1 shows the distribution of the cords' weight. Drained and transfused cords were similar, the median weight of both being 0.9 g/cm lighter than that of full cords. The average length of transfused cord was 46 cm.

    Fig 1
    Fig 1

    Distribution of weight of umbilical cords before and after blood was drained

    A similar study needs to be done on premature infants born by caesarean section, as a sizeable proportion of such infants are. Low birth weight predisposes to anaemia. If a proportionally similar cord transfusion occurs in premature infants this could be a simple, safe, no cost substitute for full placental transfusion until the problems of safely achieving placental transfusion are overcome. Indeed, for reasons other than anaemia a small placental transfusion may be ideal, as Linderkamp concluded in an extensive review.3

    References

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