The pediatric and obstetrical professions, Dr Finer et al. have
abandoned the law of cause and effect in their quest to cure the hypoxic
newborn. The original cause of hypoxia in this study was not a deficiency
of nitrous oxide. Every child in the study, however, being born in the
western world, suffered from a deficiency of blood volume due to premature
cord clamping and the consequent lack of placental transfusion which,
during physiological cord closure, increases the newborn blood volume by
30% - 50%. The extreme example of this hypovolemia in the study is the
child which died from hypoxic, ischemic encephalopathy - not enough blood
to perfuse or oxygenate the brain. Hypoxic ischemic lesions do not occur
in newborns following the normal, massive transfusion of oxygenated
placental blood at physiological birth - no cord clamp used.
Most, if not all the 36 patients were suffering from some degree of
persistent fetal circulation - incomplete closure of the foramen ovale, a
flap valve, which normally is kept closed by pressure in the left atrium
being greater than pressure in the right atrium; dilatation of pulmonary
arterioles by nitrous oxide aids this closure and decreases cyanosis. At
normal birth, the placental transfusion (PT) is an essential part of the
switch from fetal to adult circulation. Effected at high presure by
gravity and/or the contracting maternal uterus, the PT distends the
newborn heart and pulmonary vasculature and supplies the blood voume
necessary for optimal perfusion of the newly functioning lungs, gut and
kidneys. The full switch mechanism, which has been functioning well for
millions of years without cord clamps, is breifly described in my LETTER
in OBSTETRICS & GYNECOLOGY, Vol 97, No.6 June, 2001, pages 1025-1026.
Distension of the pulmonary vascular tree "erects" the alveoli and
maintains aeration. [Jaykka s. Capillary Erection and Lung Expansion. Acta
Paediatr. Scand., 1965; Supp 109]. A very adequate blood volume is needed
to maintain this pulmonary circulation and foramen ovale closure; some of
the hypovolemic consequences of immediate cord clamping (no PT) are
respiratory distress syndrome [1] ("hypovolemic shock lung") and
persistent fetal circulation. During the normal third stage of labor, (no
cord clamp) placental oxygenation and transfusion continue until pulmonary
oxygenation and the adult circulation are well established; this prevents
hypoxic brain damage. [Windle, w.f."Brain Damage by Asphyxia at Birth".
Scientific American 1969 Oct; 221(4): 76-84.]
Blood tansfusion combined with nitrous oxde therapy might have
restored these 36 patients to respiratory and circulatory normalty; it
would not have restored the neurons destroyed at birth by ischemia and
hypoxia caused by immediate cord clamping. The likelihood of any of these
36 newborns being neurologically perfect is not great.
Until the professions realize that placental transfusion is a normal
and necessary physiological event, and that the cord clamp is an extremely
dangerous instrument, pediatric reports on treating completely preventable
obstetrical tragedies will continue.
Reference:
[1] Morley, G.M. Cord Closure: Can Hasty Clamping Injure the Newborn? OBG
MANAGEMENT July 1998, 29-36.
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