title: Timing of cord clamping in very preterm infants: more evidence is needed.
abstract: In December 2012, the American College of Obstetricians and Gynecologists published a Committee Opinion entitled "Timing of umbilical cord clamping after birth." It stated that "evidence exists to support delayed cord clamping in preterm infants, when feasible. The single most important benefit for preterm infants is the possibility for a nearly 50% reduction in IVH." However, the Committee Opinion added that the ideal timing of umbilical cord clamping has yet to be determined and recommended that large clinical trials be conducted in the most preterm infants. Published randomized controlled trials include <200 infants of <30 weeks' gestation, with assessments of neurodevelopmental outcome in less than one-half of the children. This is a major gap in the evidence. Without reliable data from randomized controlled trials that optimally include childhood follow-up evaluations, we will not know whether delayed cord clamping may do more overall harm than good. Ongoing trials of delayed cord clamping plan to report childhood outcomes in >2000 additional very preterm infants. Current recommendations may need to change when these results become available. Greater international collaboration could accelerate resolution of whether this promising intervention will improve disability-free survival in about 1 million infants who will be born very preterm globally each year.
authors.affiliation: WINNER Centre for Newborn Research, NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: William O
authors.initials: WO
authors.lastname: Tarnow-Mordi
authors.affiliation: Nottingham Clinical Trials Unit, Nottingham Health Science Partners, C Floor, South Block, Queen's Medical Centre, Nottingham, UK.
authors.forename: Lelia
authors.initials: L
authors.lastname: Duley
authors.affiliation: Department of Health Sciences, University of Leicester, Leicester, UK.
authors.forename: David
authors.initials: D
authors.lastname: Field
authors.affiliation: Department of Neonatal Medicine, UCL EGA Institute for Women's Health, London, UK.
authors.forename: Neil
authors.initials: N
authors.lastname: Marlow
authors.affiliation: Perinatal Research, The Kolling Institute of Medical Research, The University of Sydney, Royal North Shore Hospital, Sydney, Australia.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Morris
authors.affiliation: School of Women's and Infants' Health, The University of Western Australia, Perth, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Newnham
authors.affiliation: Departments of Epidemiology & Biostatistics and Pediatrics & Human Development, College of Human Medicine, Michigan State University, East Lansing, MI.
authors.forename: Nigel
authors.initials: N
authors.lastname: Paneth
authors.affiliation: Department of Pediatrics, University of Vermont College of Medicine, Burlington, VT.
authors.forename: Roger F
authors.initials: RF
authors.lastname: Soll
authors.affiliation: Royal Maternity Hospital, Grosvenor Road, Belfast, Northern Ireland, UK.
authors.forename: David
authors.initials: D
authors.lastname: Sweet
mesh_terms: D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000097:blood*; D036801:Parturition; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D047928:Premature Birth; D013525:Surgical Instruments; D013997:Time Factors; D014470:Umbilical Cord / Q000601:surgery*
keywords: delayed cord clamping; placental transfusion; umbilical cord; very preterm infant