I.

ARTICLE

Early Clamping Of The Umbilical Cord May Interrupt Humankind's First 'Natural Stem Cell Transplant' 25 May 2010 The timing of umbilical cord clamping at birth should be delayed just a few minutes longer, suggest researchers at the University of South Florida's Center of Excellence for Aging and Brain Repair. Delaying clamping the umbilical cord for a slightly longer period of time allows more umbilical cord blood volume to transfer from mother to infant and, with that critical period extended, many good physiological "gifts" are transferred through 'nature's first stem cell transplant' occurring at birth. The USF review is published in a recent issue of the Journal of Cellular and Molecular Medicine(14:3). "Several clinical studies have shown that delaying clamping the umbilical cord not only allows more blood to be transferred but helps prevent anemia as well," said the paper's lead author Dr. Paul Sanberg, director of the Center. "Cord blood also contains many valuable stem cells, making this transfer of stem cells a process that might be considered 'the original stem cell transplant'." At birth, the placenta and umbilical cord start contracting and pumping blood toward the newborn. After the blood equilibrates, the cord's pulse ceases and blood flow from mother to newborn stops. In recent Western medical practice, early clamping from 30 seconds to one minute after birth -- remains the most common practice

among obstetricians and midwives, perhaps because the benefits of delaying clamping have not been clear. However, waiting for more than a minute, or until the cord stops pulsating, may be beneficial, the authors said. Birthing methods have also changed over the last century. Throughout human history and currently in cultures and areas where delivering mothers squat to deliver, gravity helps speed the stem cell transfer. Today, the cord may be clamped early for a number of reasons, including the medical resuscitation and stabilizing of infants or the notion that delaying clamping might lead to adverse effects or, more recently, to quickly facilitate umbilical cord banking. According to study co-author Dr. Dong-Hyuk Park, the relationship between cord clamping time and the transfer of stem cells needs to be understood through the early weeks of the perinatal period and the process of 'hematopoiesis,' the formation of blood cells that begins as early as two weeks into pregnancy. A transfer of pluripotent stems cells continues throughout pregnancy, however, and for a time through the umbilical cord following delivery. "Several randomized, controlled trials, systematic reviews and meta-analyses have compared the effects of late versus early cord clamping," said Dr. Park. "In pre-term infants, delaying clamping the cord for at least 30 seconds reduced incidences of intraventricular hemorrhage, late on-set sepsis, anemia, and decreased the need for blood transfusions." Another potential benefit of delayed cord clamping is to ensure that the baby can receive the complete retinue of clotting factors. Yet, there is debate and disagreement on early versus later clamping. The side favoring delayed clamping, the authors noted, cite the value of the infant's receiving umbilical cord blood (UCB)-derived stem cells, known to be pluripotent.

"The virtue of the unique and immature features of cord blood, including their ability to differentiate, are well known," added Dr. Sanberg. The researchers concluded that many common disorders in newborns related to the immaturity of organ systems may receive benefits from delayed clamping. These may include: respiratory distress; anemia; sepsis; intraventricular haemorrhage; and periventricular leukomalacia. They also speculate that other health problems, such as chronic lung disease, prematurity apneas and retinopathy of prematurity, may also be affected by a delay in cord blood clamping. "There remains no consensus among scientists and clinicians on cord clamping and proper cord blood collection," concluded co-author and obstetrician Dr. Stephen Klasko, senior vice president of USF Health and dean of the USF College of Medicine. "The most important thing is to avoid losing valuable stems cells during and just after delivery." The authors agreed that delaying cord clamping should appropriately be delayed for pre-term babies and babies born where there is no effort to bank umbilical cords, and for babies born where there is limited access to health care and where nutrition may be poor. Source: Dr. Paul Sanberg University of South Florida Health Article URL: http://www.medicalnewstoday.com/articles/189803.php Main News Category: Pregnancy / Obstetrics Also Appears In: Pediatrics / Children's Health, Nursing / Midwifery, Stem Cell Research

II. SUMMARY

The piece Early Clamping Of The Umbilical Cord May Interrupt Humankind's First 'Natural Stem Cell Transplant clearly talks about the proposal of the researchers of the University of South Floridas Center of Excellence for Aging and Brain Repair which is the delayed clamping for a little longer period of time of the newborns umbilical cord after delivery. Such practice is said to be beyond doubt advantageous especially for pre-term infants, infants born where there is no attempt to bank umbilical cords, and infants born where health care and services cannot be fully availed and where poor nutritive status frequently exists.

The benefits of the said intervention has been well justified by the authors of the study. The director of the center, Dr. Paul Sanberg, stated that delayed cord clamping aids in preventing anemia since more and extra amount of umbilical cord blood is being transferred to the newborn. In addition to this, the so called original stem cell transplant or natural first stem cell transplant freely and generously takes place due to the fact that the cord blood have many important and valuable stem cells.

It has been established by various researches and reviews which compared the noteworthy discrepancy on the consequences of early and late cord clamping that at least 30 seconds of delaying cord clamping in preterm infants trim down incidences of intraventricular hemorrhage, late on-set sepsis, anemia, and also reduced the need for blood transfusions. Other disorders or diseases that may be avoided are respiratory distress syndrome and periventrivular leukomalacia, chronic lung disease, prematurity apneas and retinopathy of prematurity. However, due to the changes of birthing methods today, Dr. Dong-Hyuk Park, emphasized the importance of carefully studying

the link that goes between the cord clamping period and the transfer of pluripotent stem cells which initiates at the early weeks of gestation and persists all right through the pregnancy and even for a time after delivery by means of the umbilical cord.

To finish, co-author and obstetrician Dr. Stephen Klasko claimed the avoidance of losing valuable stem cells in the time of and just after delivery is one significant thing that needs to be remembered and of course, practiced by the health care team.

III. REACTION

I chose this material to read and examine because I was initially captivated by the thing being talked here: the delayed clamping of the cord is said to offer many benefits particularly concerning that of the first and original natural stem cell transplant. In fact, I became a bit confused on what I learned with my maternal and child nursing class because as far as I can remember, there is no exact and definite time range being utilized when it comes to clamping and therefore cutting of the umbilical cord after the delivery of the baby. It is only clear to me that when the cords pulsation ceased already, then it is the indication to do the clamping.

As I read the article, it became more interesting. I learned that the birthing methods throughout the world are not really synchronized and I am right that there is no such accurate time to clamp the umbilical cord; it merely depends on the physicians or nurse-midwifes preference, either early or late is accepted. With these facts, I realized that the University of South Florida's Center of Excellence for Aging and Brain Repairs work is very important in the field of both medicine and nursing.

To comment with the groups findings, I can say that their data can certainly serve as basis for improved practice and care inside the delivery room. It cannot be denied that they made an excellent study since it is supported by other works, as the author claimed. However, I became disappointed since the person behind the piece has not given the particular number of the said studies and also the number of those studies that contradicted their results. In addition, the time frame the study has been going; the number of researchers involved; the place and method used and other important statistical data that were not mentioned too.

I also could not completely agree with the researchers since they have only shown one side of the childbirth management being proposed. The article purely contained the advantages and did not present even a single detriment. For me, it is imperative to see equally the two faces of this thing so that we, health care providers and even other interested parties can determine the weight of the advantages above the jeopardy that it may cause and vice versa so that we could resolve if cutting the cord late is truly good and appropriate. I also presuppose that the whole matter and every solitary statement will be more stimulating and eventually convincing if the author has looked for some parties interested to pose both affirmative and negative comments, even just few words, about the subject being examined.

IV. RECOMMENDATIONS

I see that this writing as apt and valuable to recommend to nursing students, nurses, midwives as well as for doctors since being part of the health care team, we are the ones who in fact, give quality health care to patients. If nurses and student-nurses will be able to grasp the facts that were shown in the study, then it will be of a great help to them since they could provide fresh information to their patients, the patients family

or significant others and other individuals who may be concerned enough about the matter being talked: the delayed clamping of the umbilical cord of the newborn. Health information, which can be essentially categorized as new with respect to the date the article was written or published, may be disseminated well by this means. Moreover, it is one of our responsibilities to always think about that we should give our clients the best of service and care to the summit of what we can. With this, it is fundamentally indispensable for us to view and scrutinize studies, most preferably the recent ones so as to have advanced ways and trainings.

I also suggest the general public predominantly pregnant women, their husbands or any close person to them, to read and examine this work so that they will know the most up-to-date studies which are or may be sensible to them in times where they are to encounter the situation mentioned. More so, they could actively comment and note on the results of the work that then may be functional to others, such as researchers or interested parties who would like to have the same or related studies.

These researchers or interested parties must view this as well, for them to do more comprehensive investigations to either support or oppose the data given here. It will be greatly appreciated if they will help the authors of the study to expound further the information that they have gathered and also to help them to deeply examine and analyze the association between cord clamping time and the transfer of stem cells, as what Dr. Dong-Hyuk Park mentioned.

As an end, I recommend the researchers of this study to reveal equally those studies which sustained and clashed their findings. They must add up more remarkable information, such as the disadvantages of their proposed intervention by conducting extra investigation about what they first studied.

V. SOURCE University of South Florida Health (2010, May 25). Early Clamping Of The Umbilical Cord May Interrupt Humankind's First 'Natural Stem Cell Transplant'. Medical News Today. Retrieved from http://www.medicalnewstoday.com/articles/189803.php