RT Journal Article SR Electronic T1 Respiratory support after delayed cord clamping: a prospective cohort study of at-risk births at ≥35+0 weeks gestation JF Archives of Disease in Childhood - Fetal and Neonatal Edition JO Arch Dis Child Fetal Neonatal Ed FD BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health SP fetalneonatal-2020-321503 DO 10.1136/archdischild-2020-321503 A1 Shiraz Badurdeen A1 Georgia A Santomartino A1 Marta Thio A1 Alissa Heng A1 Anthony Woodward A1 Graeme R Polglase A1 Stuart B Hooper A1 Douglas A Blank A1 Peter G Davis YR 2021 UL http://fn.bmj.com/content/early/2021/06/09/archdischild-2020-321503.abstract AB Objective To identify risk factors associated with delivery room respiratory support in at-risk infants who are initially vigorous and received delayed cord clamping (DCC).Design Prospective cohort study.Setting Two perinatal centres in Melbourne, Australia.Patients At-risk infants born at ≥35+0 weeks gestation with a paediatric doctor in attendance who were initially vigorous and received DCC for >60 s.Main outcome measures Delivery room respiratory support defined as facemask positive pressure ventilation, continuous positive airway pressure and/or supplemental oxygen within 10 min of birth.Results Two hundred and ninety-eight infants born at a median (IQR) gestational age of 39+3 (38+2–40+2) weeks were included. Cord clamping occurred at a median (IQR) of 128 (123–145) s. Forty-four (15%) infants received respiratory support at a median of 214 (IQR 156–326) s after birth. Neonatal unit admission for respiratory distress occurred in 32% of infants receiving delivery room respiratory support vs 1% of infants who did not receive delivery room respiratory support (p<0.001). Risk factors independently associated with delivery room respiratory support were average heart rate (HR) at 90–120 s after birth (determined using three-lead ECG), mode of birth and time to establish regular cries. Decision tree analysis identified that infants at highest risk had an average HR of <165 beats per minute at 90–120 s after birth following caesarean section (risk of 39%). Infants with an average HR of ≥165 beats per minute at 90–120 s after birth were at low risk (5%).Conclusions We present a clinical decision pathway for at-risk infants who may benefit from close observation following DCC. Our findings provide a novel perspective of HR beyond the traditional threshold of 100 beats per minute.Data are available upon reasonable request. Sharing of data will be considered for specific research projects. Requests should be sent to the corresponding author.