Extended Abstracts: VIIIth Recent Advances in Neonatal Medicine. An International Symposium Honoring Prof. Bo Sun. Würzburg, October 8-10, 2017

impact on pulmonary and umbilical blood flows [6, 7] . This indicates that the potential benefits may be even larger in spontaneously breathing infants when subatmospheric intrathoracic pressures are produced as compared to the supra-atmospheric pressures during positive pressure ventilation. Taking into account establishing lung aeration next to placental transfusion, the moment of clamping should be based on physiology and individualized instead of using a fixed time point. The trials in preterm infants included in the meta-analysis focused on placental transfusion and used a fixed time point, with no regard for lung aeration [4] . Also in the Australian Placental Transfusion Study, the largest trial so far (1,600 infants), cord clamping is focused on transfusion and time-based (60 s) while no respiratory effort is provided (ClinicalTrials.gov NCT02606058). In recent studies where respiratory support for preterm infants was provided close to the mother, delayed cord clamping showed no differences in outcome [8, 9] . However, in these studies the moment of cord clamping was still based on time. In the ongoing CORD trial (ISRCTN21456601), cord clamping is delayed at least 2 min while respiratory support was given. Recently, in Leiden University Medical Center cord clamping has been integrated into the stabilisation of the preterm infant. We have developed a purpose-built resuscitation table that allows infants to be kept close to their mothers, allowing the provision of standard care during stabilisation while the cord remains intact. The infant is fully monitored to ensure adequacy of ventilation and breathing effort [10] . The cord will be clamped once the infant has been stabilized and the lungs are aerated. After testing the safety and effectiveness of this approach, a large randomized trial will be planned to investigate whether this physiologically based approach of cord clamping will improve outcome.

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