Improbable but plausible research study: a randomised controlled trial of premature cord clamping vs. neonatal venesection to achieve routine prophylactic neonatal red cell reduction

摘要

Our first breath and its relationship to cord clamping literally affects us all. Presently, routine prophylactic neonatal red cell reduction is commonly achieved through premature cord clamping at birth – defined as any time before natural cessation of umbilical cord pulsations. This has two main consequences: first, restriction of the transfer of blood from the placenta to the neonate in the first minutes after birth; and second, increased blood pressure fluctuations during the liminal period of transition from fetal to adult circulation. Blood volume reduction typically averages 19 mL/kg (21% of the neonate’s total blood volume) or 18 mL/kg red cell volume (37% of the neonate’s red cell volume).1,2 Systematic reviewers examine the apologist claim that premature cord clamping may be beneficial because it reduces the rate of hyperbilirubinaemia and need for exchange transfusion.3 However, it increases the rate of neonatal anaemia, and there is evidence that the blood pressure fluctuations can cause or exacerbate cerebral damage.4 It is therefore important to explore alternative means of achieving the same end.