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Placental transfusion: may the “force” be with the baby

Journal of Perinatology volume 41, pages 1495–1504 (2021)Cite this article

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Abstract

Placental transfusion results in a significant decrease in the risk of death for extremely preterm infants. With immediate cord clamping (ICC), these infants can leave up to one-half of their normal circulating in utero blood volume in the placenta. Extremely preterm infants are at highest risk of harm from ICC yet are currently the most likely to receive ICC. Receiving a placenta transfusion provides infants with life-saving components and enhanced perfusion. We present some lesser-known but important effects of placental transfusion. New research reveals that enhanced vascular perfusion causes an organ’s endothelial cells to release angiocrine responses to guide essential functions. High progesterone levels and pulmonary artery pressure in the first few hours of life assist with neonatal adaptation. We propose that lack of essential blood volume may be a major factor contributing to inflammation, morbidities, and mortality that preterm infants frequently encounter.

Key points

  • Placental transfusion provides enhanced vascular perfusion and reduces the risk of death for preterm infants

  • Enhanced vascular perfusion stimulates endothelial cells to release vital angiocrine messengers to guide normal function and development of neonatal organs

  • High progesterone levels and pulmonary artery pressure in the first 12 h may assist the newborn to adapt to the placental transfusion throughout the body

  • Blood volume conservation is important at birth and during the NICU stay for preterm infants

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Fig. 1: Model of mechanotransduced angiocrine signals in the liver.
Fig. 2: Electron microscopy photographs of capillaries from heel biopsies of infants with immediate cord clamping (ICC) or cord clamping when pulsations stopped (±5 min, DCC).
Fig. 3: Electron micrographs of transverse sections through small muscular lung arterioles in naturally born piglets.
Fig. 4: Diagram illustrating en face shape changes in the endothelial cells of intra-acinar arteries during the first 3 weeks of life (porcine).

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Acknowledgements

The authors wish to thank John (Jack) Widness, MD, for his generous and insightful reviews of this article.

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Authors and Affiliations

  1. Neonatal Research Institute at Sharp Mary Birch Hospital for Women and Newborns, San Diego, CA, USA

    Judith S. Mercer

  2. University of Rhode Island, Kingston, RI, USA

    Judith S. Mercer & Debra A. Erickson-Owens

  3. Brighton and Sussex Medical School Royal Alexandra Childrens Hospital, Brighton, UK

    Heike Rabe

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JSM conceived of the idea for the paper; all authors made substantial contributions, revised and reviewed the article, and finally approved the paper. All authors agree to be accountable for the information presented in the paper.

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Correspondence to Judith S. Mercer.

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Mercer, J.S., Erickson-Owens, D.A. & Rabe, H. Placental transfusion: may the “force” be with the baby. J Perinatol 41, 1495–1504 (2021). https://doi.org/10.1038/s41372-021-01055-0

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