Placental transfusion in the newborn

Placental transfusion refers to the transfer of residual placental blood (~30%–40%) to the baby during the first few minutes of birth. Increasing fetal hemoglobin by placental transfusion is an extremely effective method of enhancing arterial oxygen content, increasing cardiac output, and improving oxygen delivery. The advantages of placental transfusion for the baby and also the timing of cord clamping and various methods of umbilical cord clamping such as immediate or early cord clamping, delayed cord clamping (DCC) and its advantages, umbilical cord milking (UCM) both intact UCM or cut UCM, physiological-based cord clamping, and intact cord resuscitation (ICR) are discussed. The current International Liaison Committee on Resuscitation (ILCOR, 2020) and the Neonatal Resuscitation Program (NRP, 2021) guidelines on umbilical cord clamping recommend to DCC for 30–60 s for both term and preterm infants who do not require resuscitation. DCC and UCM are safe and easy to do and associated with various benefits. UCM is a good option to be practiced in moderate preterm/term nonvigorous infants and in lower segment caesarean section babies. The favorable outcome of UCM in nonvigorous babies requiring resuscitation and also the recent ICR at the mother’s bedside are discussed. UCM may offer an advantage over DCC in newborns who are deemed too unstable to wait for 30–60 s required for DCC. UCM can be performed in any low resource setting and provides adequate placental transfusion without delay. UCM is contraindicated in extreme preterms less than 29 weeks of gestation because of the risk of intraventricular hemorrhage. ICR might be the future in nonvigorous babies.