• Neonatology
• Paediatrics

Deferring cord clamping (DCC) at birth reduces mortality in preterm infants by around a third.1 This extraordinary reduction in mortality occurs in babies of all gestations, meaning the biggest reductions in mortality could be seen in the least mature infants, who have the highest baseline risk of death. While mortality is reduced, is it almost as striking that DCC does not appear to affect major complications of prematurity such as brain injury, bronchopulmonary dysplasia, necrotising enterocolitis or late onset infection,1 leaving the intriguing question of how the benefit is mediated.

Since the publication of a systematic review in 2018,2 there has been a rapid increase in the proportion of very preterm infants (VPIs: born <32 weeks) who receive DCC. In the UK, the proportion increased from 28.9% in 2020 to 55.4% in 2022, an increase we expect to continue. Some centres exceed the 75% adherence that was managed in the trials without the use of cord intact stabilisation. However, in 2022, 25 hospitals in the UK managed DCC in less than 40% of their very preterm deliveries.

What concerns might be slowing complete adoption of this simple, cheap and evidence-based practice? Dunne et al address the question of hypothermia associated with DCC.3 The proportion of hypothermic (<36.5°C) infants on admission to their unit had increased markedly since the introduction of DCC. There is important observational evidence for an association between temperature and mortality, with one study estimating an additional 28% risk of death for each 1°C of hypothermia.4 Polyethylene bags (or wrapping) …