title: Neonatal Resuscitation with an Intact Cord: A Randomized Clinical Trial.
abstract: OBJECTIVE
  To assess whether providing ventilation during delayed cord clamping (V-DCC) increases placental transfusion compared with delayed cord clamping alone (DCC only).
  
  
  METHODS
  Inborn premature infants (230/7-316/7weeks' gestational age) were randomized to receive at least 60 seconds of V-DCC (initial continuous positive airway pressure) with addition of positive pressure ventilation if needed) or without assisted ventilation (DCC only). For the DCC-only group, infants were dried and stimulated by gently rubbing the back if apneic. The primary outcome was the peak hematocrit in the first 24 hours of life. Delivery room outcomes were analyzed from video recordings and a data acquisition system. Hemodynamic measurements were performed with the use of functional echocardiography, near-infrared spectroscopy, and electrical cardiometry.
  
  
  RESULTS
  There was no difference in the primary outcome of peak hematocrit in the first 24 hours of life. The onset of breathing was similar between both groups (25 ± 20 and 27 ± 28 seconds, P = .627); however, infants receiving DCC received a greater duration of stimulation than V-DCC (41 ± 19 and 20 ± 21 seconds P = .002). There were no differences in delivery room interventions, early hemodynamics (cerebral oxygenation by near-infrared spectroscopy, cardiac output and stroke volume by electrical cardiometry, or superior vena cava flow by of functional echocardiography), or neonatal outcomes.
  
  
  CONCLUSIONS
  V-DCC was feasible but did not lead to any measurable clinical improvements immediately after delivery or reduce subsequent neonatal morbidity. Caretakers should consider providing adequate stimulation before cord clamping.
  
  
  BACKGROUND
  ClinicalTrials.gov: NCT02231411.
authors: Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, CA. Electronic address: anup.katheria@sharp.com.
authors: Anup
authors: A
authors: Katheria
authors: Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, CA.
authors: Debra
authors: D
authors: Poeltler
authors: Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, CA.
authors: Jayson
authors: J
authors: Durham
authors: Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, CA.
authors: Jane
authors: J
authors: Steen
authors: Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, CA.
authors: Wade
authors: W
authors: Rich
authors: Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, CA.
authors: Kathy
authors: K
authors: Arnell
authors: Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, CA.
authors: Mauricio
authors: M
authors: Maldonado
authors: Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, CA.
authors: Larry
authors: L
authors: Cousins
authors: Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, CA.
authors: Neil
authors: N
authors: Finer
mesh_terms: D003250:Constriction; D036861:Delivery, Obstetric / Q000379:methods*; D004452:Echocardiography; D005260:Female; D006400:Hematocrit; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D010920:Placenta / Q000502:physiology; D011175:Positive-Pressure Respiration / Q000379:methods*; D011247:Pregnancy; D019265:Spectroscopy, Near-Infrared; D013997:Time Factors; D014470:Umbilical Cord / Q000601:surgery*
keywords: cesarean delivery; delayed cord clamping; intraventricular hemorrhage; resuscitation