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NeoReviews Vol.7 No.11 2006 e557
© 2006 American Academy of Pediatrics

International Perspectives

Cord Clamping for Stem Cell Donation: Medical Facts and Ethics

Jose Luis Diaz-Rossello, MD*

* Editorial Board

The first 300 words of the full text of this article appear below.


   Introduction
 
Evidence-based practice in neonatology benefits from the analysis of trends in knowledge and values behind a specific medical intervention as well as its conditions in different times and settings. When to clamp the umbilical cord for stem cell donation is an interesting example for this type of analysis. A discussion of the medical facts and reasons behind the current prevailing practices may show that we are waiting too long to react ... and too little to clamp the cord.

In 1472, in the first page of the first printed book in the history of medicine, Paulum Bagellardum recommended when and how to tie and cut the umbilical cord. He noted that it should be done after the newborn had been covered with a soft cloth, checked for breathing, and insufflated through the mouth if there are no respiratory movements. (1) Today, we are finally reaching similar advice, after having explored many other algorithms for 534 years.

The need to tie the cord was discussed by Ioanis Schultze in his thesis in 1733. (2) He argued that, as it happens in other mammals, it is almost unnecessary to tie the cord after the spontaneous and firm closure of the umbilical vessels.

A physiologic process of redistribution of blood and progressive cessation of umbilical flow through the cord takes place in the very tense moments immediately after birth. Minutes and even seconds count in this rapid adaptation, and the timing of cord clamping may alter this process.

A strong warning was written in 1800 by Erasmus Darwin: "Another thing very injurious to the child is the tying and cutting of the navel string too soon; which should always be left till the child has not only repeatedly breathed but till all pulsation in the cord ceases. As otherwise . . . [Full Text of this Article]






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Copyright © 2006 by the American Academy of Pediatrics.