Umbilical cord management in newborn resuscitation

At birth, blood continues to flow from the mother to baby through the intact umbilical cord. This continuum of fetal-placental circulation, now taking place between the placenta and the newborn infant has been termed ‘placental transfusion’, and it enables redistribution of blood between the placenta and the baby.1 There is usually net flow into the baby, which appears to play a role in expanding pulmonary blood.2,3 Ample clinical evidence has shown that uninterrupted placental transfusion, as supported by the practice of deferred umbilical cord clamping (DCC) reduces death, especially in preterm babies who do not require resuscitation at birth, i.e., those born in “good condition”. In an individual patient data meta-analysis (48 trials, 6367 babies <37 weeks’ GA), DCC compared to immediate clamping reduced death before discharge by almost a third (odds ratio [OR] 0.68 95% confidence interval [CI] 0.51–0.91).4 Accepted clinical practice is, therefore, to defer cord clamping in stable term and preterm infants whenever possible. Current international newborn resuscitation guidelines recommend at least 60 seconds of DCC.5 Moreover, in a sub-set of the recent individual patient data meta-analysis (47 trials, 6094 babies), deferring cord clamping beyond 120 seconds further reduced the odds of death (OR 0.31 Cl 0.11–0.80).6 We speculate these recent new insights will be considered in the next edition of resuscitation guidelines.