***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Iron deficiency anemia is a serious health problem that affects the physical and cognitive development of children . Therefore , it is important to develop cost-effective interventions to improve the hematologic status of the millions of children affected by this condition worldwide . We studied 69 Guatemalan infants who had been r and omly assigned to one of three groups at the time of delivery : 1 ) cord clamping immediately after delivery ( n = 21 ) ; 2 ) clamping when the cord stopped pulsating , with the infant placed at the level of the placenta ( n = 26 ) ; or 3 ) clamping when the cord stopped pulsating , with the newborn placed below the level of the placenta ( n = 22 ) . Maternal and infant hematologic assessment s were performed at the time of delivery and 2 mo postpartum . At baseline the groups had similar socioeconomic , demographic , and biomedical characteristics and the newborns had similar hematocrit status . Two months after delivery , infants in the two groups with delayed cord clamping had significantly higher hematocrit values and hemoglobin concentrations than did those in the early-clamping group . The percentage with hematocrit values < 0.33 was 88 % in the control group compared with 42 % in group 2 and 55 % in group 3 ( P = 0.01 ) . These results suggest that waiting until the umbilical cord stops pulsating ( approximately 1 min after delivery ) is a feasible low-cost intervention that can reduce anemia in infants in developing countries Mothers and midwives who had participated in the Bristol r and omized controlled trial of active versus physiologic management of the Third Stage of Labor were asked for their views . One hundred ninety-one mothers ( 11 % of the total r and omized ) and 49 midwives completed self-administered question naires . Both mothers and midwives commented adversely about the length of the third stage under physiologic management . In general , their views were in accord with the conclusions of the main trial ( based on clinical data , including maternal blood loss , length of third stage , need for therapeutic oxytocic agents , and specified neonatal morbidity ) in favor of continuing with the current practice of active management OBJECTIVE : This pilot study 's aim was to establish feasibility of a protocol for delayed cord clamping ( DCC ) versus immediate cord clamping ( ICC ) at preterm birth and to examine its effects on initial blood pressure and other outcomes . STUDY DESIGN : A r and omized controlled trial recruited 32 infants between 24 and 32 weeks . Immediately before delivery , mothers were r and omized to ICC ( cord clamped at 5 to 10 seconds ) or DCC ( 30- to 45-second delay in cord clamping ) groups . RESULTS : Intention-to-treat analyses revealed that the DCC group were more likely to have higher initial mean blood pressures ( adjusted OR 3.4 ) and less likely to be discharged on oxygen ( adjusted OR 8.6 ) . DCC group infants had higher initial glucose levels ( ICC=36 mg/dl , DCC=73.1 mg/dl ; p=0.02 ) . CONCLUSION : The research design is feasible . The immediate benefit of improved blood pressure was confirmed and other findings deserve consideration for further study Objective : To investigate the effects of umbilical cord milking on cardiopulmonary adaptation in very low birth weight infants . Patients and methods : This study was the secondary analysis of a r and omised control study of the effect of umbilical cord milking in premature infants . Forty singleton infants born between 24 and 28 weeks ’ gestation were r and omly assigned to groups in which the umbilical cord was clamped either immediately after birth ( control group , n = 20 ) or after umbilical cord milking ( milked group , n = 20 ) . Blood pressure , heart rate , urine output , fluid intake , and ventilatory index values in both groups were measured during the first 120 h after birth . Results : There were no significant differences in gestational age or birth weight between the two groups . The initial haemoglobin value was higher in the milked group ( mean ( SD ) 16.5 ( 1.4 ) g/dl in the milked vs 14.1 ( 1.6 ) g/dl in the control ; p<0.01 ) . During the first 12 h , blood pressure was significantly higher in the milked group . Urine output in the milked group was higher than that in the control group during the first 72 h. There were no significant differences in heart rate , water intake , or ventilatory index values between the groups . Conclusion : Umbilical cord milking may facilitate early stabilisation of both blood pressure and urine output in very low birth weight infants The purpose of this study was to characterize postnatal changes in regional Doppler blood flow velocity ( BFV ) and cardiac function of very-low-birthweight infants and to examine factors that might influence these hemodynamic changes . Mean and end-diastolic BFV of the middle cerebral and superior mesenteric arteries , cardiac output , stroke volume , and fractional shortening were measured in 20 infants birthweight 1,002 + /- 173 g , gestational age 28 + /- 2 wk ) at 6 , 30 , and 54 h after birth and before and after feedings on days 7 and 14 . Postnatal increases in cerebral BFV , mesenteric BFV , and cardiac output were observed that were not associated with changes in blood pressure , hematocrit , pH , arterial PCO(2 ) , or oxygen saturation . The postnatal pattern of relative vascular resistance ( RVR ) differed between the cerebral and mesenteric vasculatures . RVR decreased in the middle cerebral but not the superior mesenteric artery . Physiological patency of the ductus arteriosus did not alter postnatal hemodynamic changes . In response to feeding , mesenteric BFV and stroke volume increased , and mesenteric RVR and heart rate decreased . Postpr and ial responses were not affected by postnatal age or the age at which feeding was initiated . However , the initiation of enteral nutrition before 3 days of life was associated with higher prepr and ial mesenteric BFV and lower mesenteric RVR than was later initiation of feeding . We conclude that in very-low-birthweight infants over the first week of life 1 ) systemic , cerebral , and mesenteric hemodynamics exhibit region-specific changes ; 2 ) asymptomatic ductus arteriosus patency and early feedings do not significantly influence these postnatal hemodynamic changes ; and 3 ) cardiac function adapts to increase local mesenteric BFV in response to feedings Abstract The distribution of the circulatingblood volume in the infant-placental circuit at birth and in the first minutes after birth was studied in 111 normal full-term deliveries . The blood-volume of the infants , divided in groups where umbilical cords were clamped at various times , was measured by the 125 I-serum-albumin dilution method , and the placental residual blood-volume was measured by drainage both when the placenta was still in utero and after its delivery . The distribution of the blood between the infant 's and placental circuits was about 67%/33 % at birth , 80%/20 % at 1 minute , and 87%/13 % at the termination of placental transfusion BACKGROUND This study tested the hypotheses that active management of the third stage of labour  lowers the rates of primary postpartum haemorrhage ( PPH ) and longer-term consequences compared with expectant management , in a setting where both managements are commonly practised , and that this effect is not mediated by maternal posture . BACKGROUND 1512 women judged to be at low risk of PPH ( blood loss > 500 mL ) were r and omly assigned active management of the third stage ( prophylactic oxytocic within 2 min of baby 's birth , immediate cutting and clamping of the cord , delivery of placenta by controlled cord traction or maternal effort ) or expectant management ( no prophylactic oxytocic , no cord clamping until pulsation ceased , delivery of placenta by maternal effort ) . Women were also r and omly assigned upright or supine posture . Analyses were by intention to treat . FINDINGS The rate of PPH was significantly lower with active than with expectant management ( 51 [ 6.8 % ] of 748 vs 126 [ 16.5 % ] of 764 ; relative risk 2.42 [ 95 % CI 1.78 - 3.30 ] , p<0.0001 ) . Posture had no effect on this risk ( upright 92 [ 12 % ] of 755 vs supine 85 [ 11 % ] of 757 ) . Objective measures of blood loss confirmed the results . There was more vomiting in the active group but no other important differences were detected . INTERPRETATION Active management of the third stage reduces the risk of PPH , whatever the woman 's posture , even when midwives are familiar with both approaches . We recommend that clinical guidelines in hospital setting s advocate active management ( with oxytocin alone ) . However , decisions about individual care should take into account the weights placed by pregnant women and their caregivers on blood loss compared with an intervention-free third stage OBJECTIVE --To compare the effects on fetal and maternal morbidity of routine active management of third stage of labour and expectant ( physiological ) management , in particular to determine whether active management reduced incidence of postpartum haemorrhage . DESIGN --R and omised trial of active versus physiological management . Women entered trial on admission to labour ward with allocation revealed just before vaginal delivery . Five months into trial high rate of postpartum haemorrhage in physiological group ( 16.5 % v 3.8 % ) prompted modification of protocol to exclude more women and allow those allocated to physiological group who needed some active management to be switched to fully active management . Sample size of 3900 was planned , but even after protocol modification a planned interim analysis after first 1500 deliveries showed continuing high postpartum haemorrhage rate in physiological group and study was stopped . SETTING --Maternity hospital . PARTICIPANTS --Of 4709 women delivered from 1 January 1986 to 31 January 1987 , 1695 were admitted to trial and allocated r and omly to physiological ( 849 ) or active ( 846 ) management . Reasons for exclusion were : refusal , antepartum haemorrhage , cardiac disease , breech presentation , multiple pregnancy , intrauterine death , and , after May 1986 , ritodrine given two hours before delivery , anticoagulant treatment , and any condition needing a particular management of third stage . INTERVENTIONS --All but six women allocated to active management actually received it , having prophylactic oxytocic , cord clamping before placental delivery , and cord traction ; whereas just under half those allocated to physiological management achieved it . A fifth of physiological group received prophylactic oxytocic , two fifths underwent cord traction and just over half clamping of the cord before placental delivery . ENDPOINT -- Reduction in incidence of postpartum haemorrhage from 7.5 % under physiological management to 5.0 % under active management . MEASUREMENTS AND MAIN RESULTS --Incidence of postpartum haemorrhage was 5.9 % in active management group and 17.9 % in physiological group ( odds ratio 3.13 ; 95 % confidence interval 2.3 to 4.2 ) , a contrast reflected in other indices of blood loss . In physiological group third stage was longer ( median 15 min v 5 min ) and more women needed therapeutic oxytocics ( 29.7 % v 6.4 % ) . Apgar scores at one and five minutes and incidence of neonatal respiratory problems were not significantly different between groups . Babies in physiological group weighed mean of 85 g more than those in active group . When women allocated to and receiving active management ( 840 ) were compared with those who actually received physiological management ( 403 ) active management still produced lower rate of postpartum haemorrhage ( odds ratio 2.4;95 % CI1.6 to 3.7 ) . CONCLUSIONS --Policy of active management practised in this trial reduces incidence of postpartum haemorrhage , shortens third stage , and results in reduced neonatal packed cell volume Abstract This study was carried out to assess the feasibility of late cord clamping of 45 s in preterm infants delivered mainly by caesarean section and the effects on post-partal adaptation and anaemia of prematurity . Prior to delivery , 40 infants of <33 gestational weeks were r and omised to either 20 s or 45 s of late cord clamping . After the first shoulder was delivered , oxytocin was given intravenously to the mother in order to enhance placento-fetal transfusion while the infant was held below the level of the placenta . The 20 infants in group 1 ( 20 s ) had a mean birth weight of 1070 g and a mean gestational age of 29 + 4/7 weeks versus 1190 g and 30 weeks in group 2 ( 45 s ) . On day 42 of life there were ten infants without transfusions in group 2 versus three in group 1 ( P < 0.05 ) . Out of the 20 infants in group 1 , 19 and 15/19 in group 2 were delivered by caesarean section . There were no significant differences in Apgar scores , temperature on admission , heart rate , blood pressure and requirements for artificial ventilation . Conclusion Delayed cord clamping of 45 s is feasible and safe in preterm infants below 33 weeks of gestation . It is possible to perform 
    Output:
    
No r and omised trials have assessed the influence of gravity on placental transfusion .