Immediate, Delayed or Milked: Controversies around Umbilical Cord Management

The cardiorespiratory events at birth are critical for all humans to negotiate if they are to successfully transition from a fetus to a newborn and the time of umbilical cord clamping(UCC) is an important aspect of this transition. The World Health Organization estimates that 2.6 million deaths, or ~46% of all under-five deaths, occur during the neonatal period – the first 28 days of life. However, approximately 1 million of these deaths occur on the first day of life, making the day you are born one of the most dangerous days of your life. Although significant recent progress has been made, with a 50% reduction in child mortality occurring between 1990 and 2013, there is still much potential for further reductions in mortality using simple, non-expensive approaches such as delaying cord clamping and other delivery room interventions. A number of key programs have been launched, including the Helping Babies Breathe program, to improve delivery of healthcare to infants at birth, with a particular focus on the “Golden minute”. While the critical aspect of the transition is breathing/ventilation, more focus is now being placed on the management of the umbilical cord during the perinatal period.

Numerous studies have demonstrated the efficacy, and indeed benefits, of delayed umbilical cord clamping in many populations, including term and preterm infants, and more recently, in infants requiring respiratory support. There are still many unknowns about delayed cord clamping, including what the optimal time of delay should be, what populations will benefit the most, what populations may be adversely effected by delaying cord clamping, and most importantly, what are the main mechanism(s) underlying the reported benefits. The relationship between breathing or the initiation of respiratory support and the timing of umbilical cord clamping is a current hot topic with its importance still to be delineated in human populations. Another critical question is the role of umbilical cord milking where delayed cord clamping is not feasible or indeed if umbilical cord milking is preferable to delayed cord clamping in all populations, or certain sub-populations. The goal of this Research Topic is to provide a comprehensive overview of the current state-of-play of the management of the cord during neonatal transition. We aim to provide clinicians with the latest information to help assist with the management of all populations of infants, and to highlight the major gaps in knowledge in order to set a future research agenda.