Keeping babies warm and sweet after birth has been a long-held goal for those that care for the newborn, particularly very preterm babies. Add to this, adequate oxygenation and it would seem that the baby is set up for an uneventful passage through the special-care baby unit. Recent innovations have included continuous positive airways pressure, and prophylactic surfactant administration with the transitional care processes. As the urgency to lock in these measures at resuscitation increases there is an even greater anxiety that the baby is passed to the hands of the neonatal team sooner. Such pressure has always been there but are we now missing an important aspect of transition already accepted as being desirable in the term infant?

Yao et al demonstrated nearly 40 years ago that the premature infant differed from the term infant in the need for delay in clamping the umbilical cord.1 If half of the placental–fetal blood pool in the preterm lies in the fetus as opposed to two-thirds in the term infant, there is a significant volume and stem cell loss involved in immediate clamping of the cord for high-risk preterm deliveries. Given the significance of this observation in managing the problems of the preterm infant it is surprising that protocols for the delivery of high-risk preterm infants do not deal with this concern.

To date no studies have been sufficiently powered to answer important questions about immediate and long-term outcomes for preterm babies in whom there has been a delay in clamping the umbilical cord. The accumulated data from 10 randomised controlled trials that have been summarised in the Cochrane review by Rabe et al2 support the premise that there are significant …