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Table 1 Targets for further research on physiologic umbilical cord clamping

From: A physiologic approach to cord clamping: Clinical issues

  Extremely low birth weight/extremely preterm infants
  Infants with evidence of asphyxia – antepartum/intrapartum
  Infants born in low-resource settings
Intervention (delayed cord clamping with multiple covariates)
  Antenatal corticosteroid administration before preterm birth
  Type of maternal anesthesia
  Uterine activity (contractions or operative delivery without labor)
  Administration of uterotonic relative to cord clamping
  Onset of respirations relative to cord clamping
     Assisted ventilation
  Position of infant relative to placenta
  Duration of delay before clamping
Delay in cord clamping with and without resuscitation
  Initial steps (drying, clearing airway, specific stimulation to breathe)
  Positive-pressure ventilation
   Sustained inflation
   Intermittent positive-pressure ventilation
Umbilical cord milking vs. delayed cord clamping
    Active milking (length of cord segment, rate, number of passes)
    Draining of cord segment
Need for resuscitation
Physiologic characteristics during postnatal stabilization
    Blood pressure
    Blood glucose
    Need for volume expanders/pressors (per defined criteria)
    Regional blood flow – e.g. cerebral
Hemoglobin/hematocrit/iron status
Blood volume
Need for transfusion (per defined criteria)
Complications of prematurity
    Intracranial hemorrhage/periventricular leukomalacia
    Necrotizing enterocolitis
    Bronchopulmonary dysplasia/duration of supplemental oxygen
    Patent ductus arteriosus
    Premature and term infants
    Populations at high risk (genetic variations)
    Settings with limited access to phototherapy
    Term infants and growth-restricted infants
    Technique-specific differences (delayed clamping vs. umbilical cord milking)
    Toddler, preschool, elementary school outcomes
    Sex-specific differences
    Correlation with iron status
    Brain microstructure/development (advanced imaging i.e. MRI)
    Prevalence/duration of exclusive breastfeeding
Maternal obstetrical outcomes
    Physiologic characteristics postpartum
    Postpartum hemorrhage
    Intraoperative complications