Cord Management for Non-Vigorous Term and Late Preterm Newborns

Insights

Past Red Cross guidelines for term and late preterm newborns supported deferred cord clamping for 60 seconds or longer as the preferred strategy to improve outcomes, based on the International Liaison Committee on Resuscitation systematic reviews. However, newborns who remained non-vigorous at birth despite tactile stimulation were excluded from those reviews. In practice, these infants typically undergo immediate umbilical cord clamping, followed by transfer to a resuscitation area for assisted ventilation.

New evidence in term and late preterm infants (34 weeks’ gestation or more) who are not vigorous at birth show that intact umbilical cord milking reduces moderate or severe hypoxic ischemic encephalopathy and improves early hemoglobin levels, without reported adverse effects, compared with early cord clamping. Intact umbilical cord milking is defined as repeated compression of the cord from the placental side toward the baby with the connection to the placenta intact. In studies, this is described as a 20-centimeter length of cord milked for 2 seconds per time for a total of four times before cord clamping.

Intact cord milking is now suggested in preference to early cord clamping for term and late preterm infants (34 weeks’ gestation or more) who remain non-vigorous at birth despite stimulation, while deferred cord clamping remains preferred for all vigorous newborns. Evidence is insufficient to recommend intact cord resuscitation or other cord management strategies for non-vigorous infants.