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Summary Bullet Points:

Acta Paediatrica (2025) - Katheria
EBNEO Commentary on Physiological Versus Time-Based Cord Clamping in Very Preterm Infants

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• Historical Context:

  • Intact cord resuscitation dates back to the 14th century, where clamping was delayed until lung aeration occurred.

  • Early observational studies highlighted the benefits of maintaining placental circulation during initial breathing.

• Key Study – ABC3 Trial:

  • Largest RCT comparing intact cord resuscitation vs. shorter, time-based delayed cord clamping (DCC).

  • Patient-Centered Approach: Cord clamped when infants reached:

    • Peripheral oxygen saturation ≥85%

    • <40% supplemental oxygen

    • Heart rate >100 bpm

  • Minimum cord clamping time: 3 minutes; maximum: 10 minutes.

  • Early clamping if excessive maternal blood loss occurred.

  • Mean clamping time in intervention group: ~6 minutes.

• ILCOR Recommendations (2024):

  • Consider deferring cord clamping for ≥120 seconds (long DCC) when:

    • No contraindications present.

    • Adequate resources (skilled team, training, equipment, space, thermal management).

  • Insufficient evidence to recommend long DCC universally—more research needed.

  • Emphasis on feasibility, cost-effectiveness, and equity considerations.

• Key Findings & Considerations:

  • Infants with long DCC + intact cord resuscitation had lower initial temperatures.

  • Improved outcomes correlated with team experience and coordination.

  • Highlights the importance of practice, training, and behavioral skill development in neonatal resuscitation.

• Outcomes:

  • No significant differences in primary outcomes.

  • Secondary benefits observed:

    • Fewer red blood cell transfusions.

    • Lower rates of late-onset sepsis.

    • Reduced parental anxiety (family-centered outcomes).

  • Ongoing follow-up for long-term neurodevelopmental outcomes.

• Future Implications:

  • Potential neurodevelopmental benefits in preterm infants due to improved hemoglobin levels and reduced transfusions.

  • Previous research (Andersson et al.) showed improved 4-year outcomes in term infants with 3-minute DCC vs. early clamping.

  • Preterm infants may experience greater long-term benefits due to higher neurodevelopmental risk.

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References:

1. Historical context of intact cord resuscitation.

2. ILCOR (2024) consensus and recommendations.

3. Andersson et al. on long-term outcomes of DCC in term infants.

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All in all, suffering souls need to develop a new way of thinking and

feeling. And for that, they need guidance that helps them gain

perspective as well as the ability to view things as they are. This, in

turn, will help these souls practice detachment from their own

suffering and all external influences that trigger and fuel their

suffering!

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