Viktig info som MVC- och förlossningspersonal brukar hoppa över

Ocean WoW: men du kämpade tappert (: Trist att det inte var det du sökte efter..

Ja länken funkar. Fototerapi är när barnet behandlas i "sollampa" mot höga bilirubinvärden.

Vad bra att du körde den där fulingen på jobbet!  Hade nämligen nästan glömt den där Cochrane-Rewieven.

Som jag förstått det är Cochrane  en internationell icke-vinstdrivande organisation som tillhandahåller  systematiska översikter av effekterna av hälso- och sjukvård

TT publicerade den där reviewen   i april 08,  och den kom  då ut i många av  Sveriges dagstidningar.
 Jag mailade då mina  ”navelskådarvänner” (Judith Mercer, George M Morley, Sarah J  Buckley, Eileen Nicole Simon, David JR Hutchon)  och berättade om  TT-artikeln.  Fick då svar från dem att själva studien om gulsot tyvärr är förlegad och 12-15 år gammal. Och Judith Mercer berättade att hon tillsammans med Debra A. Erickson-Owens  hade skickat in en kommentar till  artikeln, men att den tyvärr inte blev synlig där av någon anledning.

Här kommer deras kommentar:
Re: Cochrane Review: Effect of timing of umbilical cord clamping of term infants on maternal and neonatal outcomes
To Whom It May Concern:
First we would like to thank Susan J. MacDonald and Philippa Middleton on completion of the huge task of reviewing all of the literature on delayed cord clamping in term infants. This is a daunting task and they are to be commended.
However, we do have two serious concerns that we feel significantly weaken this Cochrane review. Our first concern is that the evidence for an increase in “jaundice requiring phototherapy” is based upon “one” unpublished trial completed over 12 years ago by the lead author of this Cochrane Review (MacDonald) in Australia. When that one trial is removed from data (offered in Analysis 1.15) the variable of “jaundice requiring phototherapy” does not reach significance. A recent meta-analysis found in JAMA did not agree with the outcome that delayed cord clamping (DCC) leads to “jaundice requiring phototherapy.” (Hutton) We question the emphasis given to the outcome drawn from this one study.
There are several reasons in this Cochrane Review why “jaundice needing phototherapy” (associated with DCC) may be misleading. First, no information is offered to tell the reader if the providers ordering the phototherapy in the MacDonald trial were blinded to the infants grouping. Secondly, guidelines to treat jaundice have changed over time and no mention is given of what the guidelines were in Australia 12 to 16 years ago. How high were the bilirubin levels? What was the age of the infants at the time that phototherapy was indicated? Did any of the infants require further treatment such as exchange transfusions? What were the feeding policies at the time and how many mothers were breastfeeding and bottle feeding? What was the racial mix and was metabolic screening to rule out G6PD, galactosemia and other conditions considered? These questions suggest competing factors and other potential influences rather than DCC only on the incidence of jaundice needing phototherapy in McDonald’s unpublished controlled trial.
Our second main concern is that harm to infants from DCC is inferred but not demonstrated in this review. The use of the word “severe” in the Plain Language Summary is particularly misleading. Was there “harm” to any of the infants in the MacDonald study or simply more infants receiving phototherapy? What were peak bilirubin levels? The use of phototherapy does not necessary imply “severe” jaundice. Maisals (2006) recommends that the term severe be used when the total serum bilirubin level is 20 mg/dL (340 umol/L) or higher. The issue of hyperbilirubinemia is extremely complex (AAP, Technical Report 7/04). Recent information on bilirubin tells us that it is an anti-oxidant and that the elevations seen after birth especially in breastfed infants may be initially protective (Hammerman C et al, 2002). It does everyone an injustice to infer “harm” in the face of the evidence from the two large randomized controlled trials published in 2006. These trials indicate less anemia and better iron stores at 6 months of age in infants with DCC at birth.(Cernadas et al 2006; Chaparro et al, 2006). A follow-up of one trial indicates lower lead levels in infants at 6 mo. of age who had DCC after controlling for maternal lead exposure and other variables.(Chaparro 08)
In analysis 1.16 “Clinical Jaundice” did not result in significant differences between the delayed group and the immediate clamped group even though the 90 infants who were clamped at 3 minutes in the Cernadas study (2006) with no increase in jaundice are left out and the MacDonald study results are included here as well.
It is important to blind pediatric providers when one is using a management decision as an outcome variable. Strauss (2008) recently published findings on 105 preterm neonates randomized to immediate clamping or a one minute delay in cord clamping. Use of phototherapy was an outcome variable and the providers caring for the infants were not blinded to the infants grouping. He reported that even though there were “no differences in serum bilirubin values prompting therapy or in intensity of therapy required,” more infants with the delay in cord clamping group received phototherapy (Strauss, 2008) This information concerning treatment when neonatologists are unblinded to an infant’s grouping suggests that the belief that DCC causes jaundice effects clinical practice. It demonstartes the need for pediatric providers to be blinded in trials using jaundice requiring phototherapy as an outcome variable. Fortunately, Strauss balanced his variables and reported that there were no differences in initial bilirubin levels at decision to treat or in the extent of phototherapy used.
In order to prevent regional biases, we suggest that the Cochrane Collaboration recommend groups of authors representing more than one country, one continent, and one specialty. This is imperative to offer balance for such an important review.
Other points are:
1. The abstract offers that both benefits and harm are shown for late cord clamping. The evidence of harm in this review is much too weak (based on one older unpublished study’s findings) to be stated so definitively.
2. Under “Significant increase in infants needing jaundice,” five trials are listed but only one trial gives any weight to this finding and that is a 12 year old unpublished dissertation.
3. Under Authors’ Comments, the authors state “One definition of active management [of third stage labor]” but do not refer to the current definition as offered by WHO, ICM, and FIGO. It is imperative that such documents use and refer to the most current definitions.
References
AAP Technical Report. An evidence-based review of important issues concerning neonatal hyperbilirubinemia. Pediatrics 2004, 114(1):e130-153.
Cernadas, J., et al. (2006). The effect of timing of cord clamping on neonatal venous hematocrit values and clinical outcome at term: A randomized controlled trial. Obstetrical & Gynecolgical Survey,, 61(9):564-565.
Chaparro, C.M., et al. (2006). Effect of timing of umbilical cord clamping on iron status in Mexican infants: a randomised controlled trial. Lancet, 367 (9527):1997-2004.
Chaparro, C.M. et al. (2007) Early Umbilical Cord Clamping Contributes to Elevated Blood Lead Levels among Infants with Higher Lead Exposure. Journal of Pediatrics;151:506-12

Hammerman C, Goldschmidt, D, Caplan, M. S, Kaplan, M. Bromiker, R. Eidelman, A. I.et al. (2002) Protective Effect of Bilirubin in Ischemia–Reperfusion Injury in the Rat Intestine Journal of Pediatric Gastroenterology and Nutrition, 35:344–349.

Hutton, E.K. and Hassan, E.S. (2007). Late vs early clamping of the umbilical cord in full-term neonates: systematic review and meta-analysis of controlled trials. JAMA, 297(11):1241-52.
Maisels, MJ. (2006). What’s in a Name? Physiologic and pathologic ja undice: the conundrum of defining normal bilirubin levels in the newborn. Pediatrics, 118(2):805-807.
Strauss,R.G. et al. (2008). A randomized clinical trial comparing immediate versus delayed clamping of the umbilical cord in preterm infants: short-term clinical and laboratory endpoints.Transfusion, 48(4):658-65.

Respectfully submitted,
Judith S. Mercer, PhD, CNM, FACNM Debra A. Erickson-Owens, PhD(c) CNM
Clinical Professor, University of Rhode Island Senior Nurse-Midwife
Adjunct Professor of Pediatrics, Brown University Doctoral student, University of Rhode Island

Medusan: jag önskar att jag visste... Vi var på en sån där informationsträff och hon var där för att tala om Förlossningen och deras avdelning. en blond kvinna som var barnmorska där. Hon var ju trevlig tills jag ställde frågan om hur deras avnavlingsrutiner såg ut, sen vart hon tvär och tyckte nog att jag tog för mycket plats ;)

Hur långt gången är du? Om du möter henne eller någon annan knäppis på informationen så ring till hon som är avdelningsansvarig(huvudbarnmorskan?) och tala hellre med henne. Hon var toppen (:

Det där att barnmorskan ska hålla händerna på ryggen gillar jag verkligen   Det skrev jag i ett blogginlägg, Den perfekta barnmorskan,  i april förra året:

”Den perfekta barnmorskan håller sig därför avvaktande med händerna på ryggen i ett hörn i väntan på att gripa in om det skulle behövas. Hon ska alltså bara finnas där som ett stöd i bakgrunden och låta naturen sköta sig själv i mesta möjliga mån. Hon vet att det är ett helgerån att komma och störa med peang och sax under bondingens första 5 minuter.  Därför avvaktar hon  i tystnad och gör absolut ingenting så länge allt ser normalt ut. Hon varken slamrar med rondskålar eller ger andra störande ljud ifrån sig. Hon är tyst som en mus samtidigt som hon övervakar det hela med falkögon.”