Respiratory support after delayed cord clamping: a prospective cohort study of at-risk births at ≥35 +0 weeks gestation

Arch Dis Child Fetal Neonatal Ed. 2021 Nov;106(6):627-634. doi: 10.1136/archdischild-2020-321503. Epub 2021 Jun 10.


Objective: To identify risk factors associated with delivery room respiratory support in at-risk infants who are initially vigorous and received delayed cord clamping (DCC).

Design: Prospective cohort study.

Setting: Two perinatal centres in Melbourne, Australia.

Patients: At-risk infants born at ≥35+0 weeks gestation with a paediatric doctor in attendance who were initially vigorous and received DCC for >60 s.

Main outcome measures: Delivery room respiratory support defined as facemask positive pressure ventilation, continuous positive airway pressure and/or supplemental oxygen within 10 min of birth.

Results: Two hundred and ninety-eight infants born at a median (IQR) gestational age of 39+3 (38+2-40+2) weeks were included. Cord clamping occurred at a median (IQR) of 128 (123-145) s. Forty-four (15%) infants received respiratory support at a median of 214 (IQR 156-326) s after birth. Neonatal unit admission for respiratory distress occurred in 32% of infants receiving delivery room respiratory support vs 1% of infants who did not receive delivery room respiratory support (p<0.001). Risk factors independently associated with delivery room respiratory support were average heart rate (HR) at 90-120 s after birth (determined using three-lead ECG), mode of birth and time to establish regular cries. Decision tree analysis identified that infants at highest risk had an average HR of <165 beats per minute at 90-120 s after birth following caesarean section (risk of 39%). Infants with an average HR of ≥165 beats per minute at 90-120 s after birth were at low risk (5%).

Conclusions: We present a clinical decision pathway for at-risk infants who may benefit from close observation following DCC. Our findings provide a novel perspective of HR beyond the traditional threshold of 100 beats per minute.

Keywords: neonatology; respiratory.

MeSH terms

  • Australia / epidemiology
  • Cesarean Section / adverse effects
  • Cesarean Section / methods
  • Clinical Decision-Making
  • Constriction
  • Continuous Positive Airway Pressure / methods
  • Critical Pathways / standards*
  • Delivery, Obstetric* / adverse effects
  • Delivery, Obstetric* / methods
  • Delivery, Obstetric* / statistics & numerical data
  • Electrocardiography / methods*
  • Female
  • Gestational Age
  • Heart Rate
  • Humans
  • Infant, Newborn
  • Male
  • Monitoring, Physiologic / methods
  • Oxygen Inhalation Therapy* / adverse effects
  • Oxygen Inhalation Therapy* / instrumentation
  • Oxygen Inhalation Therapy* / methods
  • Risk Assessment / methods
  • Risk Factors
  • Time-to-Treatment / standards
  • Time-to-Treatment / statistics & numerical data
  • Umbilical Cord*