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Timing is everything
  1. Arjan B te Pas
  1. Correspondence to Dr Arjan B te Pas, Division of Neonatology, Department of Pediatrics, Leiden University Medical Centre, Leiden 2300 RC, The Netherlands; a.b.te_pas{at}lumc.nl

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A meta-analysis of 15 small studies comparing early (<30 s) versus late (30–180 s) cord clamping in preterm infants demonstrated a decrease in hypotension, intraventricular haemorrhage, necrotising enterocolitis and number of transfusions, as well as an increase in haematocrit and blood volume.1 The authors concluded that the meta-analysis was inconclusive due to several biases—preterm infants needing resuscitation were excluded from all the studies, for example—and considerable variation in methods.1 More research therefore needs to be done. Despite the lack of evidence, however, current neonatal resuscitation guidelines suggest delaying cord clamping for at least 30 s in preterm infants needing no resuscitation.2 So far preterm infants needing resuscitation were excluded from the studies and immediate cord clamping is still recommended in order not to delay support.

Duley et al3 have addressed this question and performed a multicentre trial in preterm infants comparing immediate cord clamping within 20 s with clamping after 2 min, providing resuscitation if needed. The results are published in this issue. Considerable hurdles had to be overcome before the caregivers in all eight participating centres felt comfortable waiting for over a minute before cord clamping; the researchers should be commended for …

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