ACOG 2025 RECOMMENDATION on Delayed Cord Clamping

The American College of Obstetricians and Gynecologists (ACOG) has issued new guidelines on deferred umbilical cord clamping in preterm babies, based on evidence showing that such delays save lives.

• Defer umbilical cord clamping for at least 60 seconds in preterm neonates born before 37 weeks of gestation who do not require immediate resuscitation.
• In neonates born between 28 0/7 and 36 6/7 weeks of gestation, when deferred clamping is not performed, umbilical cord milking is a reasonable alternative to immediate clamping to improve hematologic outcomes. 

 

 

Comparison of Early vs. Delayed Cord Clamping           

 

Parameter	Early Cord Clamping (ECC)	Delayed Cord Clamping (DCC)
Timing	Within 15–30 seconds after birth	≥30 seconds to ≥120 seconds (often 60–180 sec)
Placental transfusion	Limited	Enhanced (20–40 mL/kg additional blood volume)
Hemoglobin & Hematocrit levels	Lower	Higher
Iron stores	Reduced	Improved (lower risk of iron-deficiency anemia)
Need for RBC transfusion	Higher, especially in preterm infants	Lower, particularly <32 weeks gestation
Neonatal jaundice risk	Lower	Slightly increased (due to higher blood volume)
Polycythemia & blood viscosity	Less frequent	Slightly increased risk
Intraventricular hemorrhage (IVH)	No reduction	Reduced incidence in preterm neonates
Necrotizing enterocolitis (NEC)	No protective effect	Lower incidence in preterm infants
Cardiovascular stability	Less optimal	Improved BP regulation and perfusion
Maternal outcomes	Historically preferred for rapid resuscitation	No adverse impact; safe with proper monitoring
Clinical recommendation	Outdated standard	Recommended by WHO, ACOG, and other bodie

 📌 Note: While DCC offers substantial neonatal benefits, especially in preterm births, it requires readiness for jaundice monitoring and institutional protocols to support safe implementation.

     

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