Hi Jane, 

Our guideline for Timing of Cord Clamping for Term Babies at Christchurch Women's Hospital, New Zealand, is attached. We are in the process of updating and we now perform DCC for preterm babies as well - this will be included in the update. When we wrote the guideline in 2014 there was no evidence available for the changes in cord pH and lactate after 90 sec, and the evidence we did find was based on well babies. We could not find any evidence about changes in cord gas values for compromised babies whose cords are left intact. There is no doubt that the values change over time, especially after respirations have established, yet this is what we are aiming for. We take cord bloods for lactates when clinically indicated and most of the time results are below the threshold for follow-up when there genuinely is no cause for concern. By waiting up to 3min before clamping, we may get a small number of babies whose lactates are falsely elevated above our threshold for follow-up (5.8) which means a repeat lactate and BSL with capillary tube at 3 hours old. 

For our guideline update we are searching the literature for information on resuscitation with the cord intact, given the emerging evidence about the importance of establishing respirations before cord clamping. The Diamond Trial is ongoing in Australia where a scrubbed paediatrician brings a sterile ambubag and flat surfaced to the caesarean table and resuscitates with the cord intact so I'm looking forward to seeing these results. If anyone has any papers about deferred cord clamping for babies requiring resuscitation I would be grateful to hear about them. 

Kind regards,

Claire MacDonald DPH, RM
Christchurch, New Zealand

On Saturday, 11 August 2018, 00:07:52 GMT+12, Sandall, Jane <[log in to unmask]> wrote: