title: Neonatal outcome following cord clamping after onset of spontaneous respiration.
abstract: OBJECTIVE
  Evolving data indicate that cord clamping (CC) beyond 30 to 60 seconds after birth is of benefit for all infants. Recent experimental data demonstrated that ventilation before CC improved cardiovascular stability by increasing pulmonary blood flow. The objective was to describe the relationship between time to CC, onset of spontaneous respirations (SR), and 24-hour neonatal outcome.
  
  
  METHODS
  In a rural Tanzanian hospital, trained research assistants, working in shifts, have observed every delivery (November 2009-February 2013) and recorded data including time interval from birth to SR and CC, fetal heart rate, perinatal characteristics and outcome (normal, death, admission).
  
  
  RESULTS
  Of 15,563 infants born, 12,780 (84.3%) initiated SR at 10.8 ± 16.7 seconds, and CC occurred at 63 ± 45 seconds after birth. Outcomes included 12,730 (99.7%) normal, 31 deaths, and 19 admitted; 11,967 were of birth weight (BW) ≥2500 g and 813 <2500 g. By logistic modeling, the risk of death/admission was consistently higher if CC occurred before SR. Infants of BW <2500 g were more likely to die or be admitted. The risk of death/admission decreased by 20% for every 10-second delay in CC after SR; this risk declined at the same rate in both BW groups.
  
  
  CONCLUSIONS
  Healthy self-breathing neonates are more likely to die or be admitted if CC occurs before or immediately after onset of SR. These clinical observations support the experimental findings of a smoother cardiovascular transition when CC is performed after initiation of ventilation.
authors.affiliation: Department of Anesthesiology and Intensive Care, andSAFER (Stavanger Acute medicine Foundation for Education and Research), Stavanger University Hospital, Norway; Departments ofHealth Studies, and hege.ersdal@safer.net.
authors.forename: Hege Langli
authors.initials: HL
authors.lastname: Ersdal
authors.affiliation: SAFER (Stavanger Acute medicine Foundation for Education and Research), Stavanger University Hospital, Norway; Departments ofHealth Studies, and.
authors.forename: Jørgen
authors.initials: J
authors.lastname: Linde
authors.affiliation: SAFER (Stavanger Acute medicine Foundation for Education and Research), Stavanger University Hospital, Norway; Departments ofHealth Studies, andDepartment of Research, Haydom Lutheran Hospital, Haydom, Tanzania; and.
authors.forename: Estomih
authors.initials: E
authors.lastname: Mduma
authors.affiliation: Mathematics and Natural Sciences, University of Stavanger, Norway;
authors.forename: Bjørn
authors.initials: B
authors.lastname: Auestad
authors.affiliation: Department of Pediatrics, Weill Cornell Medical College, New York, New York.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Perlman
mesh_terms: D001775:Blood Circulation / Q000502:physiology; D003251:Constriction, Pathologic; D003326:Coronary Circulation / Q000502:physiology; D005260:Female; D005333:Fetus / Q000502:physiology; D006801:Humans; D007231:Infant, Newborn / Q000502:physiology*; D007749:Labor Stage, Third / Q000502:physiology; D021041:Placental Circulation / Q000502:physiology; D011247:Pregnancy; D011256:Pregnancy Outcome; D011652:Pulmonary Circulation / Q000502:physiology; D012119:Respiration; D013997:Time Factors; D014470:Umbilical Cord / Q000098:blood supply
keywords: cord clamping; neonatal mortality and morbidity