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The first minutes after birth are crucial for every newborn, especially for those requiring resuscitation. One important question for healthcare professionals is whether resuscitation should begin before or after cutting the umbilical cord. In recent years, delayed cord clamping has shown many benefits, such as improved circulation and iron levels in newborns. However, its role during immediate resuscitation remains unclear. A new systematic review and meta-analysis examined studies comparing newborns who were resuscitated with the umbilical cord still intact to those whose cord was clamped early. The study found that intact cord resuscitation appears to be safe, with no major differences in survival or short-term outcomes, though further research is needed to confirm its benefits for preterm infants.
When a newborn needs help to start breathing, medical teams often have to act quickly. Traditionally, this meant clamping and cutting the umbilical cord immediately to begin resuscitation away from the mother. Yet, keeping the cord intact allows continued blood flow from the placenta, which could support oxygen levels and circulation during the baby’s first breaths. Researchers wanted to know whether it is safe and effective to delay cord clamping while still providing necessary medical care right after birth.
This systematic review and meta-analysis included twelve studies, of which six were randomized controlled trials involving both preterm and term infants. The researchers compared outcomes between newborns who were resuscitated before the cord was clamped and those whose cords were cut first. They analyzed key indicators such as survival in the hospital, oxygen levels, Apgar scores, and early complications related to prematurity, like brain bleeding or intestinal inflammation.
Across all studies, there were no statistically significant differences in hospital mortality, delivery room parameters, or other neonatal outcomes between the two groups. Newborns who were resuscitated with an intact cord showed slightly higher oxygen levels five minutes after birth, suggesting better early oxygenation, though the difference was not significant. Importantly, keeping the cord intact did not increase the risk of complications such as intraventricular hemorrhage (brain bleeding), necrotizing enterocolitis, or infections.
In addition, the analysis found no major differences in the need for blood transfusions, surfactant therapy, or phototherapy. This supports the overall safety of starting resuscitation before the cord is cut. However, the authors note that many studies were small and varied in their methods, which limits the strength of the conclusions.
The review highlighted the potential role of specialized resuscitation trolleys that allow newborns to be treated while remaining attached to the placenta. Using such equipment may help reduce the risk of severe brain bleeding in preterm infants. Although this finding was not statistically significant, it points to a promising direction for improving delivery room care.
Some studies also suggested that intact cord resuscitation may lead to better oxygen saturation without increasing the risk of maternal bleeding or hypothermia. These results indicate that, when performed carefully and with the right equipment, resuscitation with an intact cord can be both feasible and safe.
For now, intact cord resuscitation can be considered a safe procedure but should be practiced mainly in hospitals with proper protocols and trained staff. The findings emphasize the importance of developing standardized approaches and equipment for use in delivery rooms. Until stronger evidence is available, preterm infants should receive this type of care only in specialized centers where teams have the necessary experience and facilities.
While this review confirms that intact cord management does not increase risks for newborns, more large and high-quality studies are needed to better understand its benefits. Future research should clarify whether this approach can improve long-term outcomes and how it can best be implemented in clinical practice.
Paper available at: Umbilical cord management in newborn resuscitation: a systematic review and meta-analysis
Full list of authors: Major, G. Sz.; Unger, V.; Nagy, R.; Hernádfői, M.; Veres, D. S.; Zolcsák, Á.; Szabó, M.; Garami, M.; Hegyi, P.; Varga, P.; Gasparics, Á.
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