Table 2:

Published RCT’s on DCC versus ECC

First Author (Year)	Placental Transfusion Method(s)	Modified Delphi Score^a	Primary Findings	Inclusion of Infants with CHD^b
Mercer JS, et al. (‘20)^c (6)	DCC, UCM^d	7	DCC infants had greater myelin content in brain regions of motor function, visual/spatial, and sensory processing than ECC infants.	No
Mercer JS, et al. (‘18)^c (35)	DCC, UCM^d	7	DCC infants had increased ferritin levels and increased brain myelin than ECC infants.	No
Mercer JS, et al. (‘17) (36)	DCC, UCM^d	7	DCC infants had increased neonatal hemoglobin and hematocrit levels at 24 to 48 hours of age with no differences on peak bilirubin levels than ECC infants.	No
Berglund SK, et al. (‘20)^e (37)	DCC	5	Hepicidin can be used to evaluate for iron deficiency in early infancy.	No
Andersson O, et al. (‘15)^c (4)	DCC	7	DCC infants had higher scores on personal- social and fine-motor development at 4 years, particularly in boys, than ECC infants.	No
Andersson O, et al. (‘14)^c (38)	DCC	7	Compared to ECC, DCC at birth did not affect iron status or neurodevelopment at age 12 months in a selected population of healthy term-born infants.	No
Andersson O, et al. (‘13)^c (39)	DCC	7	No differences between infants receiving DCC versus ECC on early development.	No
Andersson O, et al. (‘13)^c (40)	DCC	7	DCC did not have a significant effect on the maternal outcomes postpartum hemorrhage or need for blood transfusions than ECC.	No
Andersson O, et al. (‘11) (41)	DCC	7	DCC improved ferritin levels and reduced the prevalence of iron deficiency at 4 months of age than ECC.	No
Songthamwat M, et al. (‘20) (42)	DCC	5	Incidence of neonatal anemia decreased with the longer timing of DCC.	No
De Bernardo G, et al. (‘20) (43)	DCC	3	DCC infants had increased hematocrit and bilirubin levels, but without need of phototherapy, than ECC infants.	No
Rana N, et al. (‘19)^c (7)	DCC	7	DCC (3 minutes) is associated with an improvement of the neurodevelopment at 12 months of age compared to ECC.	No
Kc A, et al. (‘19)^c (44)	DCC	6	DCC increased oxygen saturation and lowers heart rate compared to ECC; time of first breath/regular breathing was earlier in infants with cord clamping > 180 seconds.	No
Andersson O, et al. (‘19)^c (45)	DCC	6	Resuscitation with an intact umbilical cord did not increase safety concerns and was associated with a better recovery than routine resuscitation after clamping and cutting the cord.	No
Kc A, et al. (‘17) (46)	DCC	7	DCC for 180 seconds lowered iron-deficiency anemia at 8 and 12 months of age than ECC.	No
Purisch SE, et al. (‘19) (47)	DCC	5	In cesarean deliveries, compared to ECC, DCC does not increase the risk of maternal hemorrhage.	No
Cavallin F, et al. (‘19) (48)	DCC	6	Among infants born by elective Cesarean- section, DCC >60 seconds increases hematocrit at day 2 of life than ECC.	No
Chen X, et al. (‘18) (49)	DCC	7	In full-term infants, DCC > 60 s increases hematocrit levels at 24 h after birth, without any harmful effects on infants and mothers, than ECC	No
Nouraie, S, et al. (‘19) (50)	DCC	4	DCC increases the risk of neonatal jaundice compared to ECC.	No
Vatansever B, et al. (‘18) (51)	DCC, UCM^f	4	ECC results in increased oxidation reactions compared to DCC/UCM.	No
Katheria AC, et al. (‘17) (52)	DCC	5	DCC (5 min) could be accomplished safely without compromising the ability to perform resuscitation and was associated with trends for less resuscitation and improved Apgar scores than ECC.	No
Sun M, et al. (‘17) (53)	DCC	3	Compared to ECC, DCC did not increase hemoglobin and hematocrit levels, highest bilirubin, Apgar scores, or hyperbilirubinemia.	No
Withanathantrige M and Goonewardene I. (‘17) (54)	DCC	6	During antepartum lower segment caesarean section, DCC is feasible and safe, and is not associated with any differences in the risk of postoperative hemorrhage or maternal or neonatal morbidity, compared to ECC.	--
De Paco C, et al. (‘16) (55)	DCC	4	DCC does not affect the time of the third stage of labor compared to ECC.	No
Backes CH, et al. (‘15) (23)	DCC	4	Among infants with critical CHD, DCC is safe, feasible and lowers the proportion of infants exposed to RBC transfusion during hospitalization, than ECC.	Yes
Nesheli HM, et al. (‘14) (56)	DCC	3	DCC increases 6-month hematological indices (hematocrit, hemoglobin, serum iron) compared to ECC.	No
Li N, et al. (‘12) (57)	DCC	4	DCC >1 minute improves iron stores of breastfed infants at 4 months compared to ECC.	--
Al-Talwil MM, et al. (‘12) (58)	DCC	6	DCC increases serum ferritin and reduces rates of iron deficiency at 3–5 months of age, compared to ECC.	No
De Paco C, et al. (‘11) (59)	DCC	4	Among vaginally delivered neonates, DCC infants had higher mean umbilical artery pO₂ values than ECC infants.	No
Ceriani Cernadas JM, et al. (‘10)^c (60)	DCC	7	At 6 months of age, DCC at 3 minutes had higher plasma ferritin levels than ECC (15 seconds).	No
Ceriani Cernadas JM, et al. (‘06) (61)	DCC	7	DCC at 3 minutes after birth increases hematocrit levels and decreases neonatal anemia than DCC at 1 minute after birth.	No
Jaleel R, et al. (‘09) (62)	DCC	3	DCC results in increase in hemoglobin levels, without adverse events, than ECC.	No
Jahazi A, et al. (‘08) (63)	DCC	3	Hematocrit and polycythemia levels did not differ between infants receiving DCC versus ECC.	No
Chaparro CM, et al. (‘07)^c (64)	DCC	7	ECC leads to higher infant blood lead concentrations at 6 months of age among infants with higher postnatal lead exposure than DCC	No
Chaparro CM, et al. (‘06) (65)	DCC	7	DCC (2 minutes) increases iron status at 6 months of age (ferritin) mean corpuscular volume, and total body iron, than ECC.	No
Van Rheenen P, et al. (‘07) (66)	DCC	5	Among infants living at risk for malaria, DCC increases hematological status (hemoglobin) and decreased risk of anemia compared to ECC.	No
Emhamed MO, et al. (‘04) (67)	DCC	4	DCC increases red cell mass compared to ECC.	No
Gupta R and Ramji S (‘02) (68)	DCC	5	Iron stores and Hb levels during infancy can be increased in neonates born to anemic mothers by DCC versus ECC	No

CHD = Congenital Heart Disease; DCC = Delayed cord clamping; ECC = Early cord clamping; UCM = Umbilical cord “milking”; -- = Unclear/not included

Referred to as “modified” as two categories had constant scores: the care provided (DCC or ECC) could not be blinded due to the intervention and the all patients (newborn infants) could be considered as “blinded” upon receipt of intervention due to age and lack of visual acumen. Thus, the maximal score is “7”, rather than “9” (34).

Determination of non-inclusion of infants with CHD was based on review of inclusion/exclusion criteria and published results; no clear evidence of inclusion was deemed non-inclusion.

Follow-up cohort

Intent of the study was to compare DCC to ECC. Authors note, “If unable to carry out the DCC protocol, or if delivery was by cesarean section, the cord was milked five times before being clamped (n=11).” (35)

Sub-analysis of data collected during previously-conducted trial (41).

Included three independent study groups: DCC versus ICC versus UCM.