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Semin Fetal Neonatal Med. 2013 Dec;18(6):385-92. doi: 10.1016/j.siny.2013.08.008. Epub 2013 Sep 19.

Promoting physiologic transition at birth: re-examining resuscitation and the timing of cord clamping.

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Section of Neonatology, University of Colorado School of Medicine, 13121 E. 17th Avenue, B8402, Aurora, CO 80045, USA. Electronic address:


Delayed clamping of the umbilical cord is recommended for term and preterm infants who do not require resuscitation. However, the approach to the newly born infant with signs of fetal compromise, prematurity and extremely low birthweight, or prolonged apnea is less clear. Human and experimental animal data show that delaying the clamping of the umbilical cord until after the onset of respirations promotes cardiovascular stability in the minutes immediately after birth. Rather than regarding delayed cord clamping as a fixed time period before resuscitation begins, a more physiologic concept of transition at birth should encompass the relative timing of onset of respirations and cord occlusion. Further research to explore the potential benefits of resuscitation with the cord intact is needed.


Asphyxia neonatorum; Blood transfusion; Blood volume; Newborn infant; Resuscitation; Umbilical cord clamping

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