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Physiological-based cord clamping in preterm infants using a new purpose-built resuscitation table: a feasibility study
  1. Emma Brouwer1,
  2. Ronny Knol1,2,
  3. Alex S N Vernooij3,
  4. Thomas van den Akker4,
  5. Patricia E Vlasman1,
  6. Frans J C M Klumper4,
  7. Philip DeKoninck5,6,
  8. Graeme R Polglase6,
  9. Stuart B Hooper6,
  10. Arjan B te Pas1
  1. 1 Division of Neonatology, Department of Paediatrics, Leiden University Medical Centre, Leiden, The Netherlands
  2. 2 Division of Neonatology, Department of Paediatrics, Erasmus University Medical Centre, Rotterdam, The Netherlands
  3. 3 Department of Medical Engineering, Leiden University Medical Centre, Leiden, The Netherlands
  4. 4 Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands
  5. 5 Department of Obstetrics and Gynaecology, Erasmus University Medical Centre, Rotterdam, The Netherlands
  6. 6 The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Clayton, Victoria, Australia
  1. Correspondence to Emma Brouwer, Division of Neonatology, Department of Paediatrics, Leiden University Medical Centre, Leiden 2300RC, The Netherlands; e.brouwer{at}


Objective Physiological-based cord clamping (PBCC) led to a more stable cardiovascular adaptation and better oxygenation in preterm lambs, but in preterm infants, this approach has been challenging. Our aim was to assess the feasibility of PBCC, including patterns of oxygen saturation (SpO2) and heart rate (HR) during stabilisation in preterm infants using a new purpose-built resuscitation table.

Design Observational study.

Setting Tertiary referral centre, Leiden University Medical Centre, The Netherlands.

Patients Infants born below 35 weeks’ gestational age.

Interventions Infants were stabilised on a new purpose-built resuscitation table (Concord), provided with standard equipment needed for stabilisation. Cord clamping was performed when the infant was stable (HR >100 bpm, spontaneous breathing on continuous positive airway pressure with tidal volumes >4 mL/kg, SpO2 ≥25th percentile and fraction of inspired oxygen (FiO2) <0.4).

Results Thirty-seven preterm infants were included; mean (SD) gestational age of 30.9 (2.4) weeks, birth weight 1580 (519) g. PBCC was successful in 33 infants (89.2%) and resulted in median (IQR) cord clamping time of 4:23 (3:00–5:11) min after birth. There were no maternal or neonatal adverse events. In 26/37 infants, measurements were adequate for analysis. HR was 113 (81–143) and 144 (129–155) bpm at 1 min and 5 min after birth. SpO2 levels were 58%(49%–60%) and 91%(80%–96%)%), while median FiO2 given was 0.30 (0.30–0.31) and 0.31 (0.25–0.97), respectively.

Conclusion PBCC in preterm infants using the Concord is feasible. HR remained stable, and SpO2 quickly increased with low levels of oxygen supply.

Trial registration number NTR6095, results.

  • neonatology
  • resuscitation
  • respiratory
  • circulatory
  • physiology

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  • EB and RK contributed equally.

  • Contributors EB, RK and ABtP wrote the ethics application, participated in the study design and coordination, trained the clinicians, collected and analysed the data and reviewed the literature. ASNV, FJCMK and SBH participated in the study design. EB, RK, ASNV, FJCMK, ABtP, SBH and PEV participated in design and development of the device. EB and RK wrote the first draft and submitted the article. All authors participated in reviewing the data and editing the manuscript. All authors have read and approved the final manuscript.

  • Funding ABtP is recipient of an NWO (Netherlands Organisation for Scientific Research) innovational research incentives scheme (VIDI 91716428). This project was sponsored by the Gisela Thier Fund (Leiden) and the Sophia Children’s Hospital Foundation (Rotterdam).

  • Competing interests None declared.

  • Patient consent Parental/guardian consent obtained.

  • Ethics approval Commissie Medische Ethiek van het Leids Universitair Medisch Centrum.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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