Abstract:
Up to 10 percent of babies require assistance at birth to commence breathing. This has been traditionally carried out away from the mother after the umbilical cord has been clamped. Early cord clamping was a routine at most births until ten years ago and remains common in any babies that need resuscitation. With increasing understanding and evidence that early cord clamping stresses the neonatal circulation causing a fall in cardiac output and long term hypovolaemia, cord clamping before respiration is established is illogical, but remains common because of the difficulty in providing PPV at the side of the mother with the umbilical cord intact. The provision of cord intact resuscitation requires preparation and optimally specially designed equipment. Monitoring the neonatal heart rate is a basic measure to determine whether the resuscitation measures are providing effective care. Most neonatal resuscitations carried out after early cord clamping are successful and there is no randomised controlled trial evidence for term babies that cord intact resuscitation is better than the traditional approach. Logically however, hypovolaemia is known to significantly affect the success of resuscitation unless and until the hypovolaemia is corrected. Clearly it is better to avoid the hypovolaemia in the first place. Logically exacerbating any hypoxic ischaemia of the cerebral circulation by clamping the cord before the pulmonary circulation is established needs to be avoided. Two good reasons why cord intact resuscitation at birth must become standard practice.
