Proposal to bleed 1/5-1/3 of a baby’s blood within 4-24 hours of birth in order to reduce neonatal jaundice

Guest blog by Emma Ashworth

A randomised controlled trial has been proposed by Andrew Weeks and Susan Bewley which aims to reduce neonatal jaundice in newborn babies.
The key ongoing argument from obstetricians, neonatologists and paediatricians who continue to cut babies’ cords immediately after birth (known as immediate cord clamping or ICC) is that babies who have delayed (about a minute) or optimal cord clamping (wait for white) have higher rates of jaundice compared to their ICC peers. Despite the fact that we are well aware of some of the dangers of ICC, which include neonatal anaemia and cerebral palsy, plus reduced fine motor skills and social functioning in 4 year olds, Weeks and Bewley argue that, “[ICC] remains entrenched, undocumented and unmonitored in the UK, which had one of the highest rates in Europe.”

The authors note that the additional cord blood available with ICC leads to a higher level of stem cells if cord blood is being collected for commercial storage, thereby giving a strong financial incentive to cut the cord immediately. They therefore suggest that rather than berating what they call “vampire capitalism”, they instead propose a randomised controlled trial which they refer to as the “PrEmature cord clamping vs. Routine umbilical vein VEnesection blood volume ReducTion study”. Take your time.

Essentially, the study suggest comparing ICC with OCC followed by an umbilical vein catheter inserted which will, over about an hour, drain off about 19ml/kg of the baby’s blood. They note that this might cause some distress to the parents, which they suggest might be offset by taking the baby away and doing the procedure in another room, playing reassuring music or encouraging the parents to watch a video. They propose that perhaps, over time, the procedure would become more acceptable and even be a part of the birth ritual “whereby the father is encouraged to participate in the ‘releasing of tension’ through the draining of blood.”

I do hope that there are no Born Stroppy readers who are not actually horrified by this proposed research project, and that you have all recognised that this is what they call an “Implausible, but not impossible” satirical suggestion. Bewley and Weeks finish their proposal with, “Those who question the satirised ethics of this RCT should also examine the ethics of inaction while premature cord clamping continues.” We agree, and we ask that everyone who reads this makes the next step of sending it to their local Trust’s neonatal, obstetric and paediatric team, MSLC/MVP and the maternity CCGs. The sooner that the dangerous practice of bleeding babies at birth through immediate cord clamping is stopped, the better.