title: Effect of delayed cord clamping (DCC) on breathing and transition at birth in very preterm infants.
abstract: BACKGROUND
  The effects of delayed cord clamping (DCC) on transition in preterm infants are important as this procedure is becoming increasingly recommended. The aim of this study was to compare the effects of DCC with an historical cohort.
  
  
  METHODS
  In this observational study, outcomes for infants ≤ 29 weeks were compared with a group born before the introduction of DCC. The intended intervention was DCC for 40s. Primary outcomes were the need for resuscitation and intubation in infants undergoing DCC, whilst taking note of their breathing during the procedure. Neonatal morbidities were analysed, including the association between breathing during DCC and outcome.
  
  
  RESULTS
  There were 62 infants in the DCC group, and 62 who received immediate cord clamping (ICC). Maternal and infant characteristics including gestational age (p = 0.76) and birth weight (p = 0.74) between groups were not significantly different. 70% of the DCC group breathed regularly at birth. Comparing the DCC and ICC groups, there was no significant difference in 1 min and 5 min Apgar scores or in the number requiring intubation at birth (p = 0.88). Likewise, admission temperatures were similar (p = 0.57). There was a significant increase in the rate of chronic lung disease in the DCC group (p = 0.013). When comparing the infants who breathed during DCC with the non-breathers; the non-breathing group was more likely to be intubated (p = 0.01), have chronic lung disease (p = 0.02), and severe intraventricular haemorrhage (p = 0.02).
  
  
  CONCLUSIONS
  DCC in these very preterm infants was well tolerated and the majority established spontaneous respiration whilst DCC was occurring. Infants who did not breathe during DCC had worse outcomes.
authors.affiliation: Neonatal Unit, Kidz First, Middlemore Hospital, Otahuhu, Private Bag 93311, Auckland, New Zealand. Electronic address: elizabeth.nevill@cmdhb.org.nz.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Nevill
authors.affiliation: Neonatal Unit, Kidz First, Middlemore Hospital, Otahuhu, Private Bag 93311, Auckland, New Zealand; Department of Paediatrics, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand. Electronic address: mmeyer@middlemore.co.nz.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Meyer
mesh_terms: D002543:Cerebral Hemorrhage / Q000503:physiopathology / Q000517:prevention & control; D003250:Constriction; D005260:Female; D006801:Humans; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D008297:Male; D036801:Parturition / Q000502:physiology*; D012119:Respiration; D014470:Umbilical Cord
keywords: Delayed cord clamping; Neonatal transition; Outcomes; Preterm infants; Resuscitation