Review question: do preterm babies benefit from receiving breathing support before the cord is clamped?

Background: allowing preterm infants to receive blood from the placenta after birth and before clamping the umbilical cord has health benefits for the baby and is not harmful for the mother. Most babies will start breathing or crying (or both) before the cord is clamped. However, some babies do not establish regular breathing during this time. After clamping the cord, most preterm babies are given some form of breathing support like continuous positive airway pressure (CPAP). CPAP applies continuous low air pressure to keep the airways open in babies who can breathe on their own. The question for this review was whether it was beneficial to start the breathing support before the cord is clamped.

Study characteristics: we searched medical databases and found one study for inclusion in this review. Preterm infants born before 32 weeks’ gestation (32 weeks from the first day of the woman’s last period (menstruation) to the current date) who had clamping of the umbilical cord delayed for 60 seconds after birth were selected at random to enter a group of babies who received breathing support and a group of babies who did not receive breathing support. The breathing support was given after birth of the baby and before the cord was clamped. Breathing support was the use of CPAP for infants breathing on their own or applying intermittent airway pressure to expand the lungs in babies not breathing well on their own. Most of the study infants (83%) were delivered by caesarean section.

Key results: the single study included in the review did not provide sufficient evidence either for or against the use of breathing support before cord clamping.

Quality of evidence: the quality of evidence was low, mainly because more infants need to be studied for definite conclusions.