Neonatal Transitional Physiology: A New Paradigm

Early clamping of the umbilical cord at birth, a practice developed without adequate evidence, causes neonatal blood volume to vary 25% to 40. Such a massive change occurs at no other time in one\u27s life without serious consequences, even death. Early cord clamping may impede a successful transition and contribute to hypovolemic and hypoxic damage in vulnerable newborns. The authors present a model for neonatal transition based on and driven by adequate blood volume rather than by respiratory effort to demonstrate how neonatal transition most likely occurs at a normal physiologic birth

Rethinking Placental Transfusion and Cord Clamping Issues

A brief delay in clamping the umbilical cord results in a placental transfusion that supplies the infant with a major source of iron during the first few months of life. Cord circulation continues for several minutes after birth and placental transfusion results in approximately 30% more blood volume. Gravity influences the amount of placental transfusion that an infant receives. Placing the infant skin-to-skin requires a longer delay of cord clamping (DCC) than current recommendations. Uterotonics are not contraindicated with DCC. Cord milking is a safe alternative to DCC when one must cut the cord prematurely. Recent randomized controlled trials demonstrate benefits for term and preterm infants from DCC. The belief that DCC causes hyperbilirubinemia or symptomatic polycythemia is unsupported by the available research. Delay of cord clamping substantively increases iron stores in early infancy. Inadequate iron stores in infancy may have an irreversible impact on the developing brain despite oral iron supplementation. Iron deficiency in infancy can lead to neurologic issues in older children including poor school performance, decreased cognitive abilities, and behavioral problems. The management of the umbilical cord in complex situations is inconsistent between birth settings. A change in practice requires collaboration between all types of providers who attend births

In the mind and in the technology: the vicarious presence of the teacher in pupil’s learning of science in collaborative group activity at the interactive whiteboard

publication-status: Publishedtypes: ArticleThe focus of research into the use of the interactive whiteboard (IWB) in the classroom has been largely in relation to teacher–pupil interaction, with very little consideration of its possible use as a tool for pupils’ collaborative endeavour. This paper is based upon an ESRC-funded project,1 which considers how pupils use the interactive whiteboard when working together on science-related activities. It provides an analysis of video and other data from science lessons in UK Years 4 and 5 primary classrooms (pupils aged 8–10 years). Concentrating on a series of lessons constructed by three (out of 12) of the project teachers, together with their written and spoken commentaries, it takes each set of lessons as a case for study and comparison. This paper focuses in particular on the nature of the ‘vicarious presence’ of the teacher evident in the group interactions at the board. We address the following questions: How is the teacher’s vicarious presence evident in the work of pupils at the interactive whiteboard? How does this presence influence the behaviour of pupils engaged in science activities? In this account, we suggest that the teacher remotely mediates the activity of the pupils at the board in two specific and interlinked ways. Firstly, the vicarious presence of the teacher seems to be in the minds of pupils, enabling them to appropriate and use introduced rules and procedures, in this case in relation to group talk. Secondly, it is in the ways in which the constructed task environment on the IWB guides and mediates the pupils’ actions, enabling them to connect with, interpret and act upon the teacher intentions for the task. Here, the teacher’s vicarious presence is in the technology. We conclude that the IWB can provide both a tool and an environment that can encourage the creation of a shared dialogic space within which co-constructed knowledge building can take place. However, this only occurs where there is active support from the teacher for collaborative, dialogic activity in the classroom and where the teacher is able to devise tasks that use board affordances to promote active learning and pupil agency

Cardiac asystole at birth: Is hypovolemic shock the cause?

A birth involving shoulder dystocia can rapidly deteriorate—from a fetus with a reassuring tracing in the minutes before birth, to a neonate needing aggressive resuscitation. Infants experiencing a traumatic birth involving shoulder dystocia may be severely compromised, even when the preceding labor was uncomplicated. This paper presents two cases in which infants had normal heart beats recorded 5–10 min before birth and were born with cardiac asystole following shoulder dystocia. Often, in cases of shoulder dystocia, infants shift blood to the placenta due to the tight compressive squeeze of the body in the birth canal (along with cord compression) and thereby may be born hypovolemic. Our hypothesis is that the occurrence of sudden cardiac asystole at birth is due to extreme hypovolemic shock secondary to the loss of blood. At birth, the sudden release of pressure on the infant’s body results in hypoperfusion resulting in low central circulation and blood pressure. Severe hypovolemic shock from these effects leads to sudden cardiac arrest. Immediate cord clamping maintains the hypovolemic state by preventing the physiologic and readily available placental blood from returning to the infant. Loss of this blood initiates an inflammatory response leading to seizures, hypoxic-ischemic encephalopathy, and brain damage or death. Animal studies have shown that human umbilical stem cells injected into a rat’s abdomen after induced brain damage, can protect the rat’s brain from developing permanent injury. To prevent damage to newborns, the infant must receive the blood volume and stem cells lost at the time of descent and immediate cord clamping. Recommended countermeasures for research include: (1) resuscitation at the perineum with intact cord; or (2) milking the cord before clamping; or (3) autologous transfusion of placenta blood after the birth; or (4) rapid transfusion of O negative blood after birth and before seizures begin

Nuchal Cord Management and Nurse-Midwifery Practice

Nuchal cord, or cord around the neck of an infant at birth, is a common finding that has implications for labor, management at birth, and subsequent neonatal status. A nuchal cord occurs in 20% to 30% of births. All obstetric providers need to learn management techniques to handle the birth of an infant with a nuchal cord. Management of a nuchal cord can vary from clamping the cord immediately after the birth of the head and before the shoulders to not clamping at all, depending on the provider\u27s learned practices. Evidence for specific management techniques is lacking. Cutting the umbilical cord before birth is an intervention that has been associated with hypovolemia, anemia, shock, hypoxic-ischemic encephalopathy, and cerebral palsy. This article proposes use of the somersault maneuver followed by delayed cord clamping for management of nuchal cord at birth and presents a new rationale based on the available current evidence

Jupiter: a Tool for Cataloging Web Resources

Library patrons conduct research using the Web, but they do not always select sites suitable for scholarly research. Since some open access Web resources complement licensed library electronic resources, library subject specialists at the University of Kansas wanted a way to direct library patrons to resources of scholarly value. The Libraries developed an easy-to-use tool for subject specialists to catalog freely available Web resources without the need to learn complex cataloging rules or to interact with overly technical systems. The utility and process for creation of descriptive records for Web resources was developed as a collection development tool. "Jupiter" is a database driven application for subject specialists to assign metadata for open access resources of scholarly value to programs at the University. The records described in Jupiter can be browsed by a locally developed subject taxonomy and are searchable through the Libraries' Information Gateway. Licensed electronic resources and freely available Web resources are organized by subject and are available through the Information Gateway for one-stop access to quality research material. Jupiter also stores records with metadata describing the subject specialists, and library patrons can refer to this information to get assistance in a specific subject area. The selection of Web resources to catalog is based on the same criteria for selecting print and licensed electronic resources. Since the implementation of Jupiter, subject specialists have learned to incorporate the evaluation and cataloging of Web sites into their collection development activities. The simple Jupiter entry form eases the cataloging task

Making the Argument for Intact Cord Resuscitation: A Case Report and Discussion

We use a case of intact cord resuscitation to argue for the beneficial effects of an enhanced blood volume from placental transfusion for newborns needing resuscitation. We propose that intact cord resuscitation supports the process of physiologic neonatal transition, especially for many of those newborns appearing moribund. Transfer of the residual blood in the placenta provides the neonate with valuable access to otherwise lost blood volume while changing from placental respiration to breathing air. Our hypothesis is that the enhanced blood flow from placental transfusion initiates mechanical and chemical forces that directly, and indirectly through the vagus nerve, cause vasodilatation in the lung. Pulmonary vascular resistance is thereby reduced and facilitates the important increased entry of blood into the alveolar capillaries before breathing commences. In the presented case, enhanced perfusion to the brain by way of an intact cord likely led to regained consciousness, initiation of breathing, and return of tone and reflexes minutes after birth. Paramount to our hypothesis is the importance of keeping the umbilical cord circulation intact during the first several minutes of life to accommodate physiologic neonatal transition for all newborns and especially for those most compromised infants