title: A physiologic approach to cord clamping: Clinical issues.
abstract: BACKGROUND
  Recent experimental physiology data and a large, population-based observational study have changed umbilical cord clamping from a strictly time-based construct to a more complex equilibrium involving circulatory changes and the onset of respirations in the newly born infant. However, available evidence is not yet sufficient to optimize the management of umbilical cord clamping.
  
  
  RESULTS
  Current guidelines vary in their recommendations and lack advice for clinicians who face practical dilemmas in the delivery room. This review examines the evidence around physiological outcomes of delayed cord clamping and cord milking vs. immediate cord clamping. Gaps in the existing evidence are highlighted, including the optimal time to clamp the cord and the interventions that should be performed before clamping in infants who fail to establish spontaneous respirations or are severely asphyxiated, as well as those who breathe spontaneously.
  
  
  CONCLUSIONS
  Behavioral and technological changes informed by further research are needed to promote adoption and safe practice of physiologic cord clamping.
authors.affiliation: Section of Neonatology, University of Colorado School of Medicine, 13121 E. 17th Avenue, Mail Stop 8402, Aurora, CO 80045 USA.
authors.forename: Susan
authors.identifier: 0000-0001-6310-8519
authors.initials: S
authors.lastname: Niermeyer
keywords: Infant, Newborn; Infant, Premature; Umbilical cord, Placental transfusion, Resuscitation, Respiration