Using delayed cord clamping to improve outcomes for very preterm infants

Evidence indicates that a delay on umbilical cord clamping leads to better outcomes for infants. What are the outcomes for those who are very preterm?

A growing body of evidence indicates that a delay in umbilical cord clamping following delivery can lead to improved outcomes for a newborn. Infants who are born preterm can use any advantage to improve outcomes. A report examines whether a delay in clamping for very preterm infants can lead to an improvement in mortality and major disability rates at 2 years of age.1

The report is a long-term follow-up evaluation of the APTS trial, a multicenter, randomized trial that was run in 25 centers in 7 countries. The infants were randomized before birth in a 1:1 ratio to delay clamping for at least 60 seconds or clamp within 10 seconds of delivery. Cord milking was not performed in either group. The outcomes were death or major disability, which included severe vision loss, cognitive delay, major language/speech problems, deafness requiring hearing aids or cochlear implants, cognitive delay, or cerebral palsy at 2 years corrected age.

A cohort of 1531 infants was randomized into delayed clamping (767) and immediate clamping (764). In the cohort, 384 infants were from a multiple delivery; 862 were male; and 505 were delivered before 27 weeks’ gestation. Protocol was fully adhered to for 565 of the infants in the delayed clamping group and 726 infants in the immediate clamping group. The investigators determined death or major disability status for 1419 infants. Death or major disability occurred in 204 infants in the delayed clamping group versus 240 infants in the immediate clamping group (relative risk [RR]) 0.83, 95% CI 0.72–0.95; p=0.010). Death before 2 years of age occurred in 60 children in the delayed clamping group and 81 in the immediate clamping group (RR 0.70, 95% CI 0.52–0.95). Major disability at age years occurred in 23% of children in the delayed clamping group and 26% in the immediate clamping subcohort (RR 0.88, 0.74–1.04).

The investigators concluded that in infants who were born very preterm that a delay of at least 60 seconds following delivery was tied to a risk reduction of death or major disability at age 2 years by 17%.


1. Robledo K, Tarnow-Mordi W, Rieger I, et al. Effects of delayed versus immediate umbilical cord clamping in reducing death or major disability at 2 years corrected age among very preterm infants (APTS): a multicentre, randomised clinical trial. Lancet Child Adolesc Health. 2022;6(3):150-157. doi: 10.1016/S2352-4642(21)00373-4