Delayed umbilical cord clamping (DCC) has been a topic of growing interest in neonatal and obstetric care, particularly for preterm infants. The American College of Obstetricians and Gynecologists (ACOG) has recently updated its clinical guidance on this practice, incorporating findings from the latest systematic reviews and meta-analyses. These revisions aim to refine clinical approaches and improve neonatal outcomes in preterm births.
Why Focus on Preterm Infants?
Preterm birth, defined as delivery before 37 weeks of gestation, is associated with higher risks of neonatal complications such as respiratory distress syndrome, intraventricular hemorrhage, and anemia. Optimizing care practices, including the timing of umbilical cord clamping, can significantly influence these outcomes. Deferred clamping allows for a more effective transfusion of placental blood to the neonate, potentially improving oxygenation and reducing the need for interventions like blood transfusions.
Key Findings from the New Evidence
ACOG’s updated guidance draws on two recent meta-analyses of randomized controlled trials. These studies included over 6,000 preterm neonates, with a median gestational age of 29 weeks. The primary findings highlighted the following:
– **Deferred cord clamping (30–180 seconds)**: Associated with a statistically significant reduction in neonatal mortality before hospital discharge (OR 0.68, 95% CI, 0.51–0.91) compared to immediate clamping (within 15 seconds).
– **Cord milking**: Did not show a statistically significant mortality benefit (OR 0.73, 95% CI, 0.44–1.20).
– **Stratification by timing**: Long deferral (≥120 seconds) demonstrated the most pronounced mortality reduction (OR 0.31, 95% CI, 0.11–0.80), while shorter deferral durations and cord milking did not yield significant benefits.
– **Other outcomes**: No significant differences in the incidence of intraventricular hemorrhage were observed across groups. However, both deferred clamping and cord milking were linked to reduced rates of red blood cell transfusion in neonates born before 32 weeks’ gestation.
Updated ACOG Recommendations
Based on these findings, ACOG now recommends the following:
– **Defer cord clamping for at least 60 seconds** in preterm neonates born before 37 weeks, provided immediate resuscitation is not required.
– For neonates born between 28 0/7 and 36 6/7 weeks, if deferred clamping is not feasible, **umbilical cord milking** is a reasonable alternative.
Considerations for Clinical Application
While the benefits of DCC are evident, the practice must be individualized based on clinical circumstances. Factors such as the need for immediate resuscitation, multiple gestations, congenital anomalies, placenta previa, and antepartum hemorrhage may preclude DCC. Multidisciplinary collaboration and adherence to evidence-based protocols are essential for successful implementation.
Future Directions
ACOG emphasizes the need for further research to validate the benefits of extended deferral (≥120 seconds) and address practical challenges such as adherence rates and applicability in non-research settings. Continued evaluation of outcomes will refine these guidelines and support the goal of optimal neonatal care.
Conclusion
The updated ACOG guidelines provide a framework for incorporating delayed umbilical cord clamping into the care of preterm infants. By aligning clinical practices with the latest evidence, healthcare providers can contribute to improved neonatal outcomes and advance the field of perinatal medicine.
References
- An Update to Clinical Guidance for Delayed Umbilical Cord Clamping After Birth in Preterm Neonates. Obstetrics & Gynecology. Published online July 24, 2025. doi:https://doi.org/10.1097/aog.0000000000006020
- Seidler AL, Aberoumand M, Hunter KE, Barba A, Libesman S, Williams JG, et al. Deferred cord clamping, cord milking, and immediate cord clamping at preterm birth: a systematic review and individual participant data meta-analysis. Lancet 2023;402:2209–22. doi: 10.1016/S0140-6736(23)02468-6
- Seidler AL, Libesman S, Hunter KE, Barba A, Aberoumand M, Williams JG, et al. Short, medium, and long deferral of umbilical cord clamping compared with umbilical cord milking and immediate clamping at preterm birth: a systematic review and network meta-analysis with individual participant data. Lancet 2023;402:2223–34. doi: 10.1016/S0140-6736(23)02469-8