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ARTICLE: Lina F. Shalak, Abbot R. Laptook, Hasan S. Jafri, Octavio Ramilo, and Jeffrey M. Perlman Clinical Chorioamnionitis, Elevated Cytokines, and Brain Injury in Term Infants Pediatrics 2002; 110: 673-680 [Abstract] [Full text] [PDF]

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Chorioamnionitis and Neonatal Brain Damage: The Unrecognized Iatrogenic Cause

Cory A Mermer   (20 December 2002)

Chorioamnionitis and Neonatal Brain Damage: The Unrecognized Iatrogenic Cause 20 December 2002
Cory A Mermer, Medical Researcher/Writer Send letter to journal: Re: Chorioamnionitis and Neonatal Brain Damage: The Unrecognized Iatrogenic Cause camermer{at}comcast.net Cory A Mermer	The findings of Shalak et al of an association between chorioamnionitis and neonatal brain damage is very interesting, but we would like to propose that the causative factor in this association has nothing to do with the actual chorioamnionitis condition or the bacteria itself. Rather, the damage is being caused iatrogenically at the time of birth by the immediate clamping of the umbilical cord. This prevents normal placental transfusion and renders the neonate significantly hypovolemic, as well as hypoxic if the lungs do not begin to function immediately or if any resucitation is necessary. Although immediate clamping is (unfortunately) a common practice, babies born in a chorioamnionitis situation have their cords clamped especially quickly for two reasons. Firstly, the infant will be taken by neonatologists immediately for evaluation and possible treatment. The sooner the cord is clamped, the faster they can evaluate the child, so it will be done with particular urgency. Secondly, because it is sometimes preferred to wait until the cord is clamped to administer antibiotics to the mother, the cord is clamped at the earliest possible moment so that the treatment of the mother can be started. Because of their being deprived of between 20% and 50% of their blood volume, these babies not only have proportionally fewer Red Blood Cells (RBCs), but they also have correspondingly fewer White Blood Cells (WBCs) and other immune factors. Thus, their infection-fighting tools are deficient, as well as their RBCs and the blood volume needed to carry these cells to all the end organs, leaving them more susceptible to adverse effects of any infection caused by the chorioamnionitis. Of course, because the blood volume (and plasma) is proportionately less, and very difficult to measure, the deficiencies in RBCs and WBCs in blood samples do not show up in lab tests. This masks the problem so that few realize what is going on. As far as we know, no one has even tried to measure WBCs independently (with a tracer) of the rest of the blood elements. If only the neonatologists could evaluate the neonate while the cord is still intact and if only the antibiotic administration to the mother could be delayed just a few minutes, the brain injuries found by Shalak et al could be avoided. It is easy to dismiss the dangers on immediate cord clamping as a non -issue, mainly because of common misconceptions. However, please take a look at some of the material available at www.cordclamping.com and in particular the paper recently presented about an association between cord clamping and brain lesions resulting in autism (1). The brain injury found by Shalak et al should serve as further evidence that the commonplace practice of immediate cord clamping should be avoided unless absolutely medically necessary. Cory Mermer Judith Mercer, CNM Eileen Simon, PhD, RN References: 1. Simon EN, Morley GMM, Brainstem Lesions in Autism: Birth Asphyxia and Ischemia as Causative Factors, presented at IMFAR autism conference, November 1, 2002. (see full presentation at http://www.cordclamping.com/IMFAR/IMFARpaper.htm )