Birth Brain Injury
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Erasmus Darwin 1770

“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 the child is much weaker than it ought to be, a portion of the blood being left in the placenta, which ought to have been in the child."

Erasmus Darwin, Zoonomia, 1801


[1] American College of Obstetricians and Gynecologists, Committee on Obstetric Practice, Umbilical Cord Blood Gas and Acid-Base Analysis, Committee Opinion, No. 348, November 2006


[2]  American College of Obstetricians and Gynecologists, Committee on Obstetric Practice, Inappropriate use of the terms Fetal Distress and Birth Asphyxia, Committee Opinion, No. 303, October 2004


[3] Frances Cowan et al. Origin and Timing of Brain Lesions in Term Infants with Neonatal Encephalopathy.  The Lancet, Vol.361, Issue 9359,1 March, 2003 pages 736-742


[4] N A Murray and I A G Roberts Neonatal transfusion practice. Arch. Dis. Child. Fetal Neonatal Ed., Mar 2004; 89: F101 – 107 “Sick neonates are one of the most heavily transfused groups of patients in modern medicine.”



[5] Linderkamp O. Placental transfusion: determinants and effects. Clinics in Perinatology 1982;9:559-592 page 560.


[6] Erasmus Darwin, Zoonomia, 1801; Vol. III page 321


[7]  Lusk WT (1882) The Science and Art of Midwifery.  New York: D Appleton and Company, pp214-215.  "Infants which have had the benefit of late ligation of the cord are red, vigorous, and active, whereas those in which the cord is tied early are apt to be pale and apathetic."


[8]  Shah, P. Riphogen, J, Beyene, J, Perlaman, M.  Multiorgan Dysfunction in Infants with Post-asphyxial Hypoxic Ischaemic Encephalopathy. Arch Dis Child Fetal Neonatal Ed 2004;89;F152-155. doi: 10.1136/adc.2002.023093


[9]  Faxelius G. Ray J. et al. Red Cell Volume Measurements and Acute Blood Loss in High Risk Infants. Pediatrics 1977;90(2):273-281.


[10] Cashmore J. Usher RH.  Hypovolemia resulting from a tight nuchal cord at birth.  Pediatr. Res 1973;7:339.


[11]  Peltonen T.  Placental Transfusion, Advantage - Disadvantage. Eur J Pediatr. 1981;137:141-146  “There is thus good reason in cases of resuscitation to keep the placental circulation intact.”


[12]  Weeks, Andrew;   Umbilical cord clamping after birth,  BMJ, 18 August 2007, Vol. 335,  pp. 311- 313