Recommended Duration for Delayed Cord Clamping
For term infants, delayed cord clamping should be performed for at least 1 minute, and for preterm infants, it should be delayed for at least 30 seconds. 1
Specific Recommendations by Gestational Age
Term Infants (≥37 weeks)
- Delay cord clamping for at least 1 minute after birth 1
- For optimal placental transfusion, delay for 3 minutes when possible 1
- Position the baby on the mother's abdomen or lower during this time 1
Preterm Infants (<37 weeks)
- Delay cord clamping for at least 30 seconds 1
- For infants 28-33+6 weeks who don't require immediate resuscitation, intact-cord milking is a reasonable alternative to delayed clamping 1
- Avoid intact-cord milking for infants <28 weeks due to insufficient evidence 1
Benefits of Delayed Cord Clamping
Term Infants
- Higher hemoglobin levels at birth 2, 3
- Improved iron stores in the first several months of life 2, 3
- Lower incidence of iron deficiency anemia 1
- Potential favorable effects on developmental outcomes 3
Preterm Infants
- Improved transitional circulation 3
- Better establishment of red blood cell volume 3
- Decreased need for blood transfusions 1, 3
- Lower incidence of necrotizing enterocolitis 3
- Lower incidence of intraventricular hemorrhage 1, 4
- Reduced need for inotropic support for hypotension 1
Special Considerations
Maternal Safety
- Delayed cord clamping is not associated with increased risk of postpartum hemorrhage 1, 3
- No significant difference in maternal blood loss at delivery 5, 3
- Safe to combine with immediate administration of oxytocin after delivery 1
Potential Concerns
- Small increase in jaundice requiring phototherapy in term infants 2, 3
- Mechanisms should be in place to monitor for and treat neonatal jaundice 3
- May reduce the chances of obtaining clinically useful cord blood units if delayed >60 seconds 5
When Immediate Resuscitation is Required
- When the infant requires immediate resuscitation, aim for at least 60 seconds of delayed clamping if possible 1
- Place the child between the legs of the mother and start positive pressure ventilation with the cord intact 1
- For infants <34 weeks requiring immediate resuscitation, individualized decisions should be made based on the severity of the condition 1
Implementation in Clinical Practice
- Delayed cord clamping should be considered standard practice for all deliveries where not contraindicated 1, 3
- Particularly important in resource-poor settings where iron deficiency and anemia are prevalent 6
- Ensure team communication and preparation for this approach during delivery planning
Delayed cord clamping is a simple, safe, and effective procedure that benefits both term and preterm infants. While the exact optimal timing continues to be studied, the evidence strongly supports delaying cord clamping for at least 30-60 seconds in most births.