Delayed cord clamping

Timing of cord clamping is believed to greatly affect placental transfusion rate and therefore neonatal and infant circulation. Delayed cord clamping of 30–60 seconds after birth, in combination with neonatal position at the level of placenta, respirations and uterine contractility increase haemoglobin and lower iron deficiency rate in both term and preterm infants. In preterm neonates, there is evidence on increased cardiovascular stability and a possible reduction of intraventricular haemorrhage and necrotising enterocolitis as well as need of blood transfusion. Adverse neonatal effects include increase of jaundice requiring phototherapy, without any adverse maternal effects reported, such as postpartum haemorrhage or anaemia. A possible adverse effect is the reduction of total nucleated cells during umbilical cord blood collection. Long term neurodevelopment has been assessed in term neonates, and a possible improvement of fine-motor and social domains in four years of life has been reported. Cord milking is an alternative technique to delayed cord clamping and as studies show, infant outcomes are at least comparable to delayed clamping. Delayed cord clamping of 30–60 seconds is therefore recommended, in both term and preterm neonates, provided there are no contra-indications and phototherapy facilities are available.