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THE EFFECT OF DEPRIVING THE INFANT OF ITS PLACENTAL BLOOD: Title and subTitle BreakON THE BLOOD PICTURE DURING THE FIRST WEEK OF LIFE FREE

Q. B. DeMARSH, M.S., B.M.; H. L. ALT, Ph.D., M.D.; W. F. WINDLE, Ph.D.; DAVID S. HILLIS, M.D.
[+] Author Affiliations

This study was made possible by a grant-in-aid of research from the John and Mary R. Markle Foundation to Dr. Windle. The staff of the Passavant Memorial Hospital cooperated in obtaining supplementary data.


JAMA. 1941;116(23):2568-2573. doi:10.1001/jama.1941.02820230012004
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Although much has been written concerning the blood of the infant, knowledge of the early postnatal blood picture including changes at birth and during the first week of life is incomplete and controversial. Our interest in the blood of the newborn was stimulated by the numerous recent reports on collection of placental blood for "blood banks." Those who have advocated the use of placental blood for transfusion purposes,1 have failed to recognize possible deleterious effects on the infant when it is deprived of this blood. It is essential to clamp the umbilical cord immediately after birth in order to salvage an adequate amount of placental blood. Even when placental blood is not collected, the practice of clamping the cord promptly at birth is a rather common one.

It is natural for the newborn infant to retrieve most of the blood in its placental circulation if severing of the cord

REFERENCES

Ascoli, M., and Vercesi, C.: Boll. d. Soc. ital. di biol. sper. 9:814, 1934;; cited by Barton and Hearne.
Bruskin, Y. M., and Farberova, P. S.: Sovet. vrach. zhur. , (Oct. 30) , 1936;, pp. 1546-1551
abstracted, J. A. M. A. 107:2098 ( (Dec. 19) ) 1936;.
Stavskaya, E.: Novy khir. archiv. 37:72, 1936;
abstracted, J. A. M. A. 108: 1226 ( (April 3) ) 1937;.
Gwynn, C. A., and Alsever, J. B.: Am. J. M. Sc. 198:634 ( (Nov.) ) 1939;.
Halbrecht, J.: Lancet 1:202 ( (Jan. 28) ) 1939;
2:1263 (Dec. 16) 1939.
Page, A. P. M.; Seager; K. G., and Ward, E. M.: Lancet 1:200 ( (Jan. 28) ) 1939;.
Barton, F. E., and Hearne, T. M.:  Use of Placental Blood for Transfusion , J. A. M. A. 113: 1475 ( (Oct. 14) ) 1939;.
Heyl, W. M.: Am J. Obst. & Gynec. 39: 679 ( (April) ) 1940;.
Fine, C. S.; Alter, R. L., and Baptisti, Arthur: Am. J. Obst. & Gynec. 39:462 ( (March) ) 1940;.
Haselhorst, G., and Allmeling, A.: Ztschr. f. Geburtsh. u. Gynäk. 98: 103, 1930;.
Goodall, J. R.; Anderson, L. O.; Altimas, G. T., and McPhail, F. L.: Surg., Gynec. & Obst. 66: 176 ( (Feb.) ) 1938;.
Grodberg, B. C., and Carey, E. L.: New England J. Med. 219: 471 ( (Sept. 29) ) 1938;.
Barcroft, J., and Kennedy, J. A.: J. Physiol. 95:173 ( (Feb. 14) ) 1939;.
Lucas, W. P., and Dearing, B. F.:  Blood Volume in Infants Estimated by the Vital Dye Method , Am. J. Dis. Child. 21:96 ( (Jan.) ) 1921;.
We are at present studying the blood volume of newborn infants by the Evans blue method and find it to be much lower (10 per cent of body weight) than reported by Lucas and Dearing.6 The placental blood therefore is probably equal to an even greater percentage of the blood volume of the infant than indicated above.
According to adult standards, 15 Gm. of hemoglobin equals approximately 100 per cent.
Hélot, P.: Union méd. de la Seine-inf. 16:193, 1877;
cited by Porak, p. 370.
Hayem, G.: Cong. period. intenat. d. sc. méd. Compt. rend. , 1878;, p. 211
cited by Porak, p. 370.
Porak, C.: Ann. de gynéc. 10: 189, 291, 363 and 446, 1878;.
Börner, R.: Arch. f. d. ges. Physiol. 220:717, 1928;.
Phillips, B. I.: Unpublished data
Osgood, E. E.: A Textbook of Laboratory Diagnosis , Philadelphia, P. Blakiston's Son & Co., 1935;.
Frischkorn, H. B., and Rucker, M. P.: Am. J. Obst. & Gynec. 38:592 ( (Oct.) ) 1939;. Schiff.25
DeMarsh, Q. B.; Windle, W. F., and Alt, H. L.: Proc. Soc. Exper. Biol. & Med. 44:662 ( (June) ) 1940;.
Pulsations indicate that the arterial channels to the placenta are unoccluded. Cessation of pulsation is not an indication that the placental vessels have emptied themselves of blood. Expulsion of blood from capillaries and veins of the placenta into the infant appears to be accomplished by uterine compression of the placenta as well as by casoconstriction of its vessels.
Only 500 corpuscles were examined in the two cover slips in several preparations.
Windle, W. F.; Sweet, Marion, and Whitehead, W. H.: Anat. Rec. 78:321-332 [ (Nov. 25) ] 1940;
Waugh, T. R.; Merchant, F. T., and Maughan, G. B.: Am. J. M. Sc. 198:646 ( (Nov.) ) 1939;.
Osgood, E. E.: A Textbook of Laboratory Diagnosis , Philadelphia, The Blakiston Company, 1940;
Haden, R. L., and Neff, F. C.:  Volume Index and Color Index of Red Blood Corpuscles in New-Born Infants , Am. J. Dis. Child. 28: 458 ( (Oct.) ) 1924;.
Duke, W. W., and Stofer, D. D.:  Comparison of Capillary and Venous Blood in Pernicious Anemia , Arch. Int. Med. 30: 94 ( (July) ) 1922;.
Lucas, W. P.; Dearing, B. F.; Hoobler, H. R.; Cox, Anita; Jones, Martha R., and Smyth, F. S.:  Blood Studies in Newborn: Morphological; Chemical; Coagulation; Urobilin and Bilirubin , Am. J. Dis. Child. 22:525 ( (Dec.) ) 1921;.
Andersen, Bent, and Ortmann, Gudrun: Acta med. Scandinav. 93:410, 1937;.
Izquierdo, J. J., and Cannon, W. B.: Am. J. Physiol. 84:545 ( (April) ) 1928;
CannonAm. J. Physiol. 86: 145 ( (Aug.) ) 1928;.
Windle, W. F.: Physiology of the Fetus , Philadelphia, W. B. Saunders Company, 1940;.
Taylor, D. B., and Gotsev, T.: Unpublished data; cited by Barcroft, J.: The Brain and Its Environment , New Haven, Conn., Yale University, Press, 1938;.
Horváth, Zaltán, and Hollósi, Charles:  Birth Pains and the Blood of the Newborn , Am. J. Dis. Child. 49:689 ( (March) ) 1935;.
Krumbhaar, E. B.: J. Lab. & Clin. Med. 8:11 ( (Oct.) ) 1922;.
Seyfarth, C., and Jürgens, R.: Virchows Arch. f. path. Anat. 266:676, 1928;.
Goldbloom, Alton, and Gottlieb, Rudolph:  Icterus Neonatorum , Am. J. Dis. Child. 38:57 ( (July) ) 1929;.
Josephs, H. W.: Medicine 15: 307 ( (Sept.) ) 1936;.
Wollstein, Martha:  Normal Blood in Infants and Children , in Downey, H.: Handbook of Hematology , New York, Paul B. Hoeber, Inc., 1938;, vol. 2, p. 924.
Franklin, Morris: Am. J. Obst. & Gynec. 22:913 ( (Dec.) ) 1931;.
Schiff, E.: Jahrb. f. Kinderh. 34: 159 and 459, 1892;.
Engel, G.: Zentralbl. f. Gynäk. 9: 721, 1885;.
Fullerton, H. W.: Arch. Dis. Childhood 12:91 ( (April) ) 1937;.
Stearns, Genevieve, and McKinley, J. B.: J. Nutrition 13:143 ( (Feb.) ) 1937;.
Blood in placenta = 125 cc.; hemoglobin 16 Gm. per hundred cubic centimeters; hemoglobin = 0.335 per cent iron Total iron in placental blood = 1.25 × 16 × 0.00335 = 67 mg. Infant age 4 months: Average weight = 5.5 Kg.; blood volume = 10.9 per cent;13 hemoglobin = 12 Gm./100 cc. Total circulating hemoglobin iron = 5.5 × 10.9 × 12 × 0.00335 = 241 mg. Total circulating hemoglobin iron minus iron in placental blood (241 - 67) = 174 mg. Theoretic hemoglobin of infant (depleted of iron reserve) deprived of the amount of iron present in placental blood. 174/241 × 12 Gm. = 8.7 Gm. per hundred cubic centimeters
Since this article was submitted for publication many more determinations of the red corpuscles and hemoglobin have been made simultaneously on sinus and heel blood of newborn infants. Contrary to our first few observations, we find the values to be consistently lower in sinus blood. The difference in number of red corpuscles and amount of hemoglobin between the immediate and delay groups is similar to that found in capillary (heel) blood. The red corpuscles and hemoglobin in sinus blood show a sharp rise within an hour after birth in the delay group but not in the immediate group. Reticulocyte percentages in sinus blood in the two groups show the same difference found in capillary blood. These results will be reported in detail in a subsequent publication.

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Ascoli, M., and Vercesi, C.: Boll. d. Soc. ital. di biol. sper. 9:814, 1934;; cited by Barton and Hearne.
Bruskin, Y. M., and Farberova, P. S.: Sovet. vrach. zhur. , (Oct. 30) , 1936;, pp. 1546-1551
abstracted, J. A. M. A. 107:2098 ( (Dec. 19) ) 1936;.
Stavskaya, E.: Novy khir. archiv. 37:72, 1936;
abstracted, J. A. M. A. 108: 1226 ( (April 3) ) 1937;.
Gwynn, C. A., and Alsever, J. B.: Am. J. M. Sc. 198:634 ( (Nov.) ) 1939;.
Halbrecht, J.: Lancet 1:202 ( (Jan. 28) ) 1939;
2:1263 (Dec. 16) 1939.
Page, A. P. M.; Seager; K. G., and Ward, E. M.: Lancet 1:200 ( (Jan. 28) ) 1939;.
Barton, F. E., and Hearne, T. M.:  Use of Placental Blood for Transfusion , J. A. M. A. 113: 1475 ( (Oct. 14) ) 1939;.
Heyl, W. M.: Am J. Obst. & Gynec. 39: 679 ( (April) ) 1940;.
Fine, C. S.; Alter, R. L., and Baptisti, Arthur: Am. J. Obst. & Gynec. 39:462 ( (March) ) 1940;.
Haselhorst, G., and Allmeling, A.: Ztschr. f. Geburtsh. u. Gynäk. 98: 103, 1930;.
Goodall, J. R.; Anderson, L. O.; Altimas, G. T., and McPhail, F. L.: Surg., Gynec. & Obst. 66: 176 ( (Feb.) ) 1938;.
Grodberg, B. C., and Carey, E. L.: New England J. Med. 219: 471 ( (Sept. 29) ) 1938;.
Barcroft, J., and Kennedy, J. A.: J. Physiol. 95:173 ( (Feb. 14) ) 1939;.
Lucas, W. P., and Dearing, B. F.:  Blood Volume in Infants Estimated by the Vital Dye Method , Am. J. Dis. Child. 21:96 ( (Jan.) ) 1921;.
We are at present studying the blood volume of newborn infants by the Evans blue method and find it to be much lower (10 per cent of body weight) than reported by Lucas and Dearing.6 The placental blood therefore is probably equal to an even greater percentage of the blood volume of the infant than indicated above.
According to adult standards, 15 Gm. of hemoglobin equals approximately 100 per cent.
Hélot, P.: Union méd. de la Seine-inf. 16:193, 1877;
cited by Porak, p. 370.
Hayem, G.: Cong. period. intenat. d. sc. méd. Compt. rend. , 1878;, p. 211
cited by Porak, p. 370.
Porak, C.: Ann. de gynéc. 10: 189, 291, 363 and 446, 1878;.
Börner, R.: Arch. f. d. ges. Physiol. 220:717, 1928;.
Phillips, B. I.: Unpublished data
Osgood, E. E.: A Textbook of Laboratory Diagnosis , Philadelphia, P. Blakiston's Son & Co., 1935;.
Frischkorn, H. B., and Rucker, M. P.: Am. J. Obst. & Gynec. 38:592 ( (Oct.) ) 1939;. Schiff.25
DeMarsh, Q. B.; Windle, W. F., and Alt, H. L.: Proc. Soc. Exper. Biol. & Med. 44:662 ( (June) ) 1940;.
Pulsations indicate that the arterial channels to the placenta are unoccluded. Cessation of pulsation is not an indication that the placental vessels have emptied themselves of blood. Expulsion of blood from capillaries and veins of the placenta into the infant appears to be accomplished by uterine compression of the placenta as well as by casoconstriction of its vessels.
Only 500 corpuscles were examined in the two cover slips in several preparations.
Windle, W. F.; Sweet, Marion, and Whitehead, W. H.: Anat. Rec. 78:321-332 [ (Nov. 25) ] 1940;
Waugh, T. R.; Merchant, F. T., and Maughan, G. B.: Am. J. M. Sc. 198:646 ( (Nov.) ) 1939;.
Osgood, E. E.: A Textbook of Laboratory Diagnosis , Philadelphia, The Blakiston Company, 1940;
Haden, R. L., and Neff, F. C.:  Volume Index and Color Index of Red Blood Corpuscles in New-Born Infants , Am. J. Dis. Child. 28: 458 ( (Oct.) ) 1924;.
Duke, W. W., and Stofer, D. D.:  Comparison of Capillary and Venous Blood in Pernicious Anemia , Arch. Int. Med. 30: 94 ( (July) ) 1922;.
Lucas, W. P.; Dearing, B. F.; Hoobler, H. R.; Cox, Anita; Jones, Martha R., and Smyth, F. S.:  Blood Studies in Newborn: Morphological; Chemical; Coagulation; Urobilin and Bilirubin , Am. J. Dis. Child. 22:525 ( (Dec.) ) 1921;.
Andersen, Bent, and Ortmann, Gudrun: Acta med. Scandinav. 93:410, 1937;.
Izquierdo, J. J., and Cannon, W. B.: Am. J. Physiol. 84:545 ( (April) ) 1928;
CannonAm. J. Physiol. 86: 145 ( (Aug.) ) 1928;.
Windle, W. F.: Physiology of the Fetus , Philadelphia, W. B. Saunders Company, 1940;.
Taylor, D. B., and Gotsev, T.: Unpublished data; cited by Barcroft, J.: The Brain and Its Environment , New Haven, Conn., Yale University, Press, 1938;.
Horváth, Zaltán, and Hollósi, Charles:  Birth Pains and the Blood of the Newborn , Am. J. Dis. Child. 49:689 ( (March) ) 1935;.
Krumbhaar, E. B.: J. Lab. & Clin. Med. 8:11 ( (Oct.) ) 1922;.
Seyfarth, C., and Jürgens, R.: Virchows Arch. f. path. Anat. 266:676, 1928;.
Goldbloom, Alton, and Gottlieb, Rudolph:  Icterus Neonatorum , Am. J. Dis. Child. 38:57 ( (July) ) 1929;.
Josephs, H. W.: Medicine 15: 307 ( (Sept.) ) 1936;.
Wollstein, Martha:  Normal Blood in Infants and Children , in Downey, H.: Handbook of Hematology , New York, Paul B. Hoeber, Inc., 1938;, vol. 2, p. 924.
Franklin, Morris: Am. J. Obst. & Gynec. 22:913 ( (Dec.) ) 1931;.
Schiff, E.: Jahrb. f. Kinderh. 34: 159 and 459, 1892;.
Engel, G.: Zentralbl. f. Gynäk. 9: 721, 1885;.
Fullerton, H. W.: Arch. Dis. Childhood 12:91 ( (April) ) 1937;.
Stearns, Genevieve, and McKinley, J. B.: J. Nutrition 13:143 ( (Feb.) ) 1937;.
Blood in placenta = 125 cc.; hemoglobin 16 Gm. per hundred cubic centimeters; hemoglobin = 0.335 per cent iron Total iron in placental blood = 1.25 × 16 × 0.00335 = 67 mg. Infant age 4 months: Average weight = 5.5 Kg.; blood volume = 10.9 per cent;13 hemoglobin = 12 Gm./100 cc. Total circulating hemoglobin iron = 5.5 × 10.9 × 12 × 0.00335 = 241 mg. Total circulating hemoglobin iron minus iron in placental blood (241 - 67) = 174 mg. Theoretic hemoglobin of infant (depleted of iron reserve) deprived of the amount of iron present in placental blood. 174/241 × 12 Gm. = 8.7 Gm. per hundred cubic centimeters
Since this article was submitted for publication many more determinations of the red corpuscles and hemoglobin have been made simultaneously on sinus and heel blood of newborn infants. Contrary to our first few observations, we find the values to be consistently lower in sinus blood. The difference in number of red corpuscles and amount of hemoglobin between the immediate and delay groups is similar to that found in capillary (heel) blood. The red corpuscles and hemoglobin in sinus blood show a sharp rise within an hour after birth in the delay group but not in the immediate group. Reticulocyte percentages in sinus blood in the two groups show the same difference found in capillary blood. These results will be reported in detail in a subsequent publication.
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