Related Experiment Video
Updated: May 1, 2026
Preterm EEG: A Multimodal Neurophysiological Protocol
Published on: February 18, 2012
Timing of cord clamping in very preterm infants: more evidence is needed
William O Tarnow-Mordi1, Lelia Duley2, David Field3
1WINNER Centre for Newborn Research, NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia.
Insights
Delayed umbilical cord clamping may reduce intraventricular hemorrhage (IVH) in preterm infants. More research is needed to confirm benefits and rule out potential harms before widespread adoption.
Area of Science:
- Neonatal Medicine
- Perinatal Research
- Evidence-Based Obstetrics
Background:
- The American College of Obstetricians and Gynecologists (2012) noted evidence supporting delayed cord clamping in preterm infants.
- A potential benefit includes a nearly 50% reduction in intraventricular hemorrhage (IVH).
- However, the optimal timing remains undetermined, necessitating further large-scale clinical trials.
Purpose of the Study:
- To highlight the current evidence gap regarding the ideal timing of umbilical cord clamping.
- To emphasize the need for robust randomized controlled trials (RCTs) with long-term neurodevelopmental follow-up.
- To underscore the importance of international collaboration for definitive conclusions on delayed cord clamping.
Main Methods:
- Review of existing published randomized controlled trials (RCTs) on umbilical cord clamping.
- Identification of limitations in current trials, particularly sample size and neurodevelopmental outcome assessments.
- Consideration of ongoing RCTs with planned childhood outcome evaluations in over 2000 very preterm infants.
Main Results:
- Existing RCTs involve fewer than 200 infants (<30 weeks gestation).
- Neurodevelopmental outcomes have been assessed in less than half of the infants in published trials.
- A significant gap exists in reliable data to determine if delayed clamping offers more overall benefit than harm.
Conclusions:
- Current recommendations on delayed cord clamping may require revision based on upcoming trial results.
- Reliable RCT data, including childhood follow-up, is crucial to ascertain the true impact of delayed cord clamping.
- International collaboration can expedite understanding of this intervention's effect on disability-free survival for very preterm infants.
Abstract:
In December 2012, the American College of Obstetricians and Gynecologists published a Committee Opinion entitled "Timing of umbilical cord clamping after birth." It stated that "evidence exists to support delayed cord clamping in preterm infants, when feasible. The single most important benefit for preterm infants is the possibility for a nearly 50% reduction in IVH." However, the Committee Opinion added that the ideal timing of umbilical cord clamping has yet to be determined and recommended that large clinical trials be conducted in the most preterm infants. Published randomized controlled trials include <200 infants of <30 weeks' gestation, with assessments of neurodevelopmental outcome in less than one-half of the children. This is a major gap in the evidence. Without reliable data from randomized controlled trials that optimally include childhood follow-up evaluations, we will not know whether delayed cord clamping may do more overall harm than good. Ongoing trials of delayed cord clamping plan to report childhood outcomes in >2000 additional very preterm infants. Current recommendations may need to change when these results become available. Greater international collaboration could accelerate resolution of whether this promising intervention will improve disability-free survival in about 1 million infants who will be born very preterm globally each year.
