Cord clamping—the long view

There is now a strong body of evidence favouring delay in clamping the umbilical cord at birth, both in term and preterm births. ‘Delay’, now badged as the novel practice, is of course the physiological option, and ‘early’ cord clamping is the untested intervention that crept in along with other aspects of the active management of birth from the 1970s onwards; such is the topsy-turvy nature of the advancement of knowledge and practice. But most of the randomised trials in both term and preterm babies have focused on relatively short term outcomes in infancy, so it is refreshing to read a paper describing participants' developmental outcome at the age of 4 years. Andersson et al (JAMA Pediatr doi:10.1001/jamapediatrics.2015.0358) managed to follow up almost 70% of their original babies, though considerably more families in the early cord clamping group declined to participate before the 4 year follow up. The authors reported both group averages and proportions below a pre-defined threshold: those allocated to delayed clamping had advantages in fine motor, personal/social and processing speed domains, but the disadvantage from early clamping was much more pronounced in boys than girls. We clearly need more and …