When should the umbilical cord be clamped

#### The bottom line At birth, if the umbilical cord is not clamped immediately blood flow between the baby and placenta continues for a short time; this continued placental transfusion is part of the physiological transition from fetal to neonatal circulation.1 Clamping the cord too quickly may restrict the infant’s ability to cope with this transition.2 3 Healthy babies at term usually adapt without major consequences, but this may affect wellbeing in those born preterm or with an impaired cardiorespiratory circulation. A brief delay in cord clamping may increase neonatal blood volume, but a longer delay may have other advantages, such as a smoother cardiorespiratory transition and more stable blood pressure, irrespective of net change in blood volume. For very preterm infants (<32 weeks’ gestation), improved blood pressure stability may reduce the risk of intraventricular haemorrhage.4 Concerns about deferring (delaying) cord clamping include exacerbation of jaundice, increased blood viscosity owing to greater red cell mass, delayed respiratory support, and hypothermia. There is no agreement on what constitutes early or deferred cord clamping. At term, placental transfusion is usually complete by two minutes but may continue for up to five minutes,5 and it contributes up to a …