Pediatrics Commentary: Further Insights into Cord Management

SOURCE: Roger F. Soll; Further Insights Into Cord ManagementPediatrics 2023; e2023063505. 10.1542/peds.2023-063505

Management of the umbilical cord at birth has changed dramatically during the past decade. In both term and preterm infants, the previous standard of immediate early cord clamping has been shown to be inferior to a variety of other umbilical cord management techniques. 

Delayed (or deferred) cord clamping (DCC) (for anywhere from 30 seconds to minutes of life) is the most extensively tested approach to optimizing placental transfusion. In preterm infants, delayed umbilical cord clamping is associated with improved transitional circulation, improved hematologic measures, and lower incidence of mortality and major disability.

However, there are concerns regarding DCC for a critical group of infants: those thought to be in need of immediate resuscitation. Two additional approaches have been suggested in these circumstances: umbilical cord milking (UCM) and DCC with resuscitation with an intact cord. Umbilical cord milking allows for more rapid placental transfusion by “milking” the umbilical cord in the direction of the infant before clamping the cord. Delayed cord clamping with resuscitation is a more complex intervention, allowing for resuscitation with the cord intact. Although delayed cord clamping with resuscitation has been shown to be feasible for providing placental transfusion in preterm neonates in need of respiratory support, the relative ease of performing UCM leads many to assume that this approach should be preferred.

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Companion Paper: A companion to this article can be found online at