McDonnell 1997.

Methods	Randomised controlled trial, stratified by vaginal or CS, 26 to 29 weeks, 30 to 33 weeks.
Participants	Inclusion criteria Infants at 26 to 33 weeks' gestation Vaginal or CS Single or multiple pregnancies. 4 sets of twins included with each twin randomised separately. N = 46 babies Exclusion criteria Severe fetal distress, IUGR with abnormal umbilical Doppler waveforms, fetal hydrops, fetal malformations, Rhesus incompatibility.
Interventions	Intervention: DCC Cord clamped at 30 secs, infant positioned between legs of the mother Syntocinon at birth of the infant N = 23 babies Comparator: ECC Cord clamped immediately N = 23 babies Additional information Gestational subgroup: < 32‐34 weeks' gestation Resuscitation with cord intact: not available Access to NICU: yes Length of delay: 30 secs Baby placed: between mother's legs Uterotonic: syntocinon given IV after birth of infant according to standard practice UCM: n/a Comparison 1 DCC with neonatal resuscitation after cord clamping vs ECC (subgroup by gestation) Subgroup 1: < 32‐34 weeks' gestation Comparison 2 DCC with neonatal resuscitation after cord clamping vs ECC (subgroup by type intervention) Subgroup 1: DCC at < 1 min with baby level with uterus and placenta
Outcomes	Primary outcome: Hct at 4 hrs. Secondary outcomes: Apgar score, temperature on admission, requirement for ventilation, oxygen, surfactant, peak serum bilirubin, inotropic support, cerebral ultrasound, blood transfusion, death
Notes	Setting: Sydney, Australia Dates: January to December 1994 Declaration of interest: not reported Trial funding source: not reported Further information Unit of randomisation was the infant ‐ so for twin pregnancies each infant was randomised separately M McDonnell kindly provided additional information regarding this study
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Sequence not stated. There was stratification by gestational age and type of delivery.
Allocation concealment (selection bias)	Unclear risk	Quote: “sealed opaque envelopes”. Not clear if envelopes numbered and used sequentially.
Blinding of participants and personnel (performance bias) All outcomes	High risk	Blinding was not mentioned. It is possible that lack of blinding could influence other aspects of care and the recording of outcomes.
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Blinding was not mentioned. It is possible that lack of blinding could influence other aspects of care and the recording of outcomes.
Incomplete outcome data (attrition bias) All outcomes	High risk	46 infants were randomised. It was not clear in the publication how many infants were in each randomised group and we understand that personal communication with the authors provided the information and data. For the outcomes, of IVH and PVL there were only 31/46 (67%) of data available though death is reported on all babies. Analysis was according to randomisation group.
Selective reporting (reporting bias)	Unclear risk	Assessment of risk of bias from published trial report. Several outcomes were not reported in the brief trial report although the authors offer other data on request. We did not assess the trial protocol.
Other bias	Unclear risk	Groups appeared similar at baseline although there were more boys in the immediate clamping group (15 vs 9, denominators not clear).