Slow to change: New cord clamping policies for premature infants

Recently, the American College of Obstetricians & Gynecologists (ACOG) recommended a 30–60 second delay in umbilical cord clamping for all preterm deliveries [1]. Delayed cord clamping in preterm infants has been associated with a greater than 50% reduction in intraventricular hemorrhage and less need for blood transfusions as demonstrated in a recent Cochrane meta-analysis of 10 randomized controlled trials of delayed cord clamping compared to immediate cord clamping [2]. The AAP has endorsed the ACOG statement and the Neonatal Resuscitation Program has also recommended that cord clamping should be delayed for at least 1 minute [1, 3, 4]. These statements should change the standard of care for all preterm deliveries by eliminating immediate cord clamping (ICC). A recent survey conducted of US obstetricians, however, demonstrated that only 12% of responders had an umbilical cord clamping policy [5]. The most frequent response for why there was no policy for optimal timing of umbilical cord clamping, regardless of gestational age, was “don’t know.” The potential for neonatal red blood cell transfusion was the only reason cited for performing a delay of cord clamping, while