Historical Evidence and Current Concepts of Neonatal Transition

Dawes and other researchers of his time gathered considerable data on changes in circulation through the heart and lungs that must take place at birth.  Respiratory function is transferred from the placenta to the infant's lungs, but how quickly?  Clamping of the umbilical cord is a human invention, and current protocol mandates clamping the cord as soon as possible after birth.  Transition from placental to pulmonary respiration is thus assumed to take place within seconds of birth.  Most infants breathe immediately at birth, but those who do not must rely on neonatologists to quickly establish inflation and function of the lungs.

Data from research going back at least to 1878 exists on blood volume left in the placenta, and weight gained by the neonate when placental circulation is allowed to continue for up to 20 minutes or more following birth.  Some studies were based on comparing the effects of immediate versus late clamping of the umbilical cord, but the conclusion of most, up through the 1930s and 40s, was that waiting for pulsations of the cord to cease was healthiest.

The effects of bilirubin on the infant brain have been the focus of research going back at least to 1875, with highpoint in the 1960s of RhoGAM (anti-D) treatment for Rh-negative mothers.   Association of placental transfusion with polycythemia and hyperbilirubinemia in the 1970s appears to have been a major incentive for the current protocol to clamp the umbilical cord as soon as possible after birth.

Ranck and Windle in 1959 observed ischemic brainstem damage in newborn monkeys subjected to asphyxia, by preventing onset of pulmonary respiration (delivering the infant head into a saline-filled sac) and clamping the umbilical cord.  Damage was most severe in the midbrain auditory pathway, which in human children would be an impediment to speech development.  The current protocol for clamping the umbilical cord immediately at birth should be reviewed in light of much historical evidence that this may be unsafe.  It should be considered as possibly responsible for recent increases in autism and other developmental disorders.  More at http://www.placentalrespiration.net/.

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Notes

Abstract

Poster 2

FNPS 2006