Cord clamping in term and pre-term infants: how should clinicians proceed?

Graeme R Polglase and Michael Stark
Med J Aust 2018; 208 (8): . || doi: 10.5694/mja17.01287
Published online: 26 February 2018

Evidence favours delayed cord clamping in most newborns, but further studies are needed

Recommendation For pre-term and term infants who do not require respiratory support, it is advisable to delay umbilical cord clamping for at least 60 seconds 

  • 1 Ritchie Centre, Hudson Institute of Medical Research, Melbourne, VIC
  • 2 Monash University, Melbourne, VIC
  • 3 Women's and Children's Health Network, Adelaide, SA
  • 4 Robinson Research Institute, University of Adelaide, Adelaide, SA


This research was supported by a joint National Heart Foundation of Australia and National Health and Medical Research Council Research Fellowship (GRP: 1105526) and by the Victorian Government’s Operational Infrastructure Support Program.

Competing interests:

No relevant disclosures.

  • 1. Perlman JM, Wyllie J, Kattwinkel J, et al. Part 7: neonatal resuscitation — 2015 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Circulation 2015; 132: S204-S241.
  • 2. Fogarty M, Osborn DA, Askie L, et al. Delayed vs early umbilical cord clamping for preterm infants: a systematic review and meta-analysis. Am J Obstet Gynecol 2018; 218: 1-18.
  • 3. Tarnow-Mordi W, Morris J, Kirby A, et al. Delayed versus immediate cord clamping in preterm infants. N Engl J Med 2017; 377: 2445-2455.
  • 4. Popat H, Robledo KP, Sebastian L, et al. Effect of delayed cord clamping on systemic blood flow: a randomized controlled trial. J Pediatr 2016; 178: 81-86.e2.
  • 5. Bhatt S, Alison BJ, Wallace EM, et al. Delaying cord clamping until ventilation onset improves cardiovascular function at birth in preterm lambs. J Physiol 2013; 591: 2113-2126.
  • 6. Ersdal HL, Linde J, Mduma E, et al. Neonatal outcome following cord clamping after onset of spontaneous respiration. Pediatrics 2014; 134: 265-272.
  • 7. Nevill E, Meyer MP. Effect of delayed cord clamping (DCC) on breathing and transition at birth in very preterm infants. Early Hum Dev 2015; 91: 407-411.
  • 8. Polglase GR, Dawson JA, Kluckow M, et al. Ventilation onset before umbilical cord clamping (physiological-based cord clamping) improves systemic and cerebral oxygenation in preterm lambs. PLoS One 2015; 10: e0117504.
  • 9. Katheria A, Poeltler D, Durham J, et al. Neonatal resuscitation with an intact cord: a randomized clinical trial. J Pediatr 2016; 178: 75-80.e3.
  • 10. Wyckoff MH, Aziz K, Escobedo MB, et al. Part 13: neonatal resuscitation — 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 2015; 132: S543-S560.
  • 11. Sweet DG, Carnielli V, Greisen G, et al. European consensus guidelines on the management of respiratory distress syndrome — 2016 update. Neonatology 2017; 111: 107-125.
  • 12. Committee on Obstetric Practice, American College of Obstetricians and Gynecologists. Committee opinion no. 543: timing of umbilical cord clamping after birth. Obstet Gynecol 2012; 120: 1522-1526.
  • 13. National Institute for Health and Care Excellence. Preterm labour and birth: NICE guideline (NG25) [website]. London: NICE; 2015. (viewed Feb 2018).
  • 14. Ersdal HL, Linde J, Auestad B, et al. Timing of cord clamping in relation to start of breathing or ventilation among depressed neonates-an observational study. BJOG 2016; 123: 1370-1377.
  • 15. Stark MJ, Hodyl NA, Belegar VKK, Andersen CC. Intrauterine inflammation, cerebral oxygen consumption and susceptibility to early brain injury in very preterm newborns. Arch Dis Child Fetal Neonatal Ed 2016; 101: F137-F142.
  • 16. Andersen CC, Pillow JJ, Gill AW, et al. The cerebral critical oxygen threshold of ventilated preterm lambs and the influence of antenatal inflammation. J Appl Physiol 2011; 111: 775-781.
  • 17. Sehgal A, Allison BJ, Gwini SM, et al. Vascular aging and cardiac maladaptation in growth-restricted preterm infants. J Perinatol 2018; 38: 92-97.
  • 18. Sehgal A, Allison BJ, Gwini SM, et al. Cardiac morphology and function in preterm growth restricted infants: relevance for clinical sequelae. J Pediatr 2017; 188: 128-134.e2
  • 19. Polglase GR, Allison BJ, Coia E, et al. Altered cardiovascular function at birth in growth-restricted preterm lambs. Pediatr Res 2016; 80: 538-546.
  • 20. Polglase GR, Blank DA, Barton SK, et al. Physiologically based cord clamping stabilises cardiac output and reduces cerebrovascular injury in asphyxiated near-term lambs. Arch Dis Child Fetal Neonatal Ed 2017; [Epub ahead of print].
  • 21. Katheria AC, Brown MK, Faksh A, et al. Delayed cord clamping in newborns born at term at risk for resuscitation: a feasibility randomized clinical trial. J Pediatr 2017; 187: 313-317.e1.


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