Table 1 Targets for further research on physiologic umbilical cord clamping
From: A physiologic approach to cord clamping: Clinical issues
Population | ||
  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 | ||
|  |    Spontaneous | |
|  |    Assisted ventilation | |
  Position of infant relative to placenta | ||
  Duration of delay before clamping | ||
Comparison | ||
Delay in cord clamping with and without resuscitation | ||
| Â | Initial steps (drying, clearing airway, specific stimulation to breathe) | |
| Â | Positive-pressure ventilation | |
| Â | Â | Sustained inflation |
| Â | Â | CPAP |
| Â | Â | 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 | |
Outcome | ||
Need for resuscitation | ||
Physiologic characteristics during postnatal stabilization | ||
|  |   Temperature | |
|  |   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 | |
Hyperbilirubinemia | ||
|  |   Premature and term infants | |
|  |   Populations at high risk (genetic variations) | |
|  |   Settings with limited access to phototherapy | |
Polycythemia | ||
|  |   Term infants and growth-restricted infants | |
|  |   Technique-specific differences (delayed clamping vs. umbilical cord milking) | |
Neurodevelopment | ||
|  |   Toddler, preschool, elementary school outcomes | |
|  |   Sex-specific differences | |
|  |   Correlation with iron status | |
|  |   Brain microstructure/development (advanced imaging i.e. MRI) | |
Behavior | ||
|  |   Prevalence/duration of exclusive breastfeeding | |
Mortality | ||
Maternal obstetrical outcomes | ||
|  |   Physiologic characteristics postpartum | |
|  |   Postpartum hemorrhage | |
|  |   Intraoperative complications | |