***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: Objective To compare the effect of early cord clamping ( ECC ) vs. delayed cord clamping ( DCC ) on hematocrit and serum ferritin at 6 wk of life in preterm infants . Methods This r and omized controlled trial was conducted in the delivery room and neonatal intensive care unit of a tertiary hospital . One hundred preterm infants born between 30 0/7 and 36 6/7 wk were r and omized to either early or delayed cord clamping groups . Parental informed consent was obtained prior to the delivery . In the ECC group , the cord was clamped immediately after the delivery of the baby and in the DCC group ; the cord was clamped beyond 2 min after the baby was delivered . Hematocrit and serum ferritin at 6 wk of life were the primary outcomes . Incidence of anemia , polycythemia and significant jaundice were the main secondary outcomes . Results The mean hematocrit ( 27.3 ± 3.8 % vs. 31.8 ± 3.5 % , p value 0.00 ) and the mean serum ferritin ( 136.9 ± 83.8 ng/mL vs. 178.9 ± 92.8 ng/mL , p value 0.037 ) at 6 wk of age were significantly higher in the infants r and omized to DCC group . The hematocrit on day 1 was also significantly higher in the DCC group ( 50.8 ±5.2 % vs. 58.5 ±5.1 % , p value 0.00 ) . The DCC group required significantly longer duration of phototherapy ( 55.3 ± 40.0 h vs. 36.7 ± 32.6 h , p value 0.016 ) and had a trend towards higher risk of polycythemia . Conclusions Delaying the cord clamping by 2 min , significantly improves the hematocrit value at birth and this beneficial effect continues till at least 2nd mo of life OBJECTIVES Low superior vena cava ( SVC ) flow is common in the first hours after very preterm birth and has a strong association with subsequent periventricular/intraventricular hemorrhage . We report the neurodevelopmental outcome at 3 years of age of very preterm babies who had serial echocardiographic studies , including measures of SVC flow , during the first 48 hours after birth . STUDY DESIGN A prospect i ve observational study was performed on a cohort of 126 babies ( < 30 weeks ) , 103 of whom survived to discharge . Neurodevelopmental follow-up data , which included abnormal developmental quotient , abnormal motor score , and cerebral palsy , were available for 93 % of this cohort at 3 years of age . Relations between 3-year outcome and early hemodynamic measures and clinical parameters were explored . RESULTS After controlling for confounding variables , average SVC flow over the first 24 hours of life was significantly associated with the primary outcome of death or survival with any disability ( P=.004 ) and with the secondary outcome of abnormal developmental quotient ( P = .006 ) . A greater number of low SVC flow readings during the first 24 hours was significantly related to death and adverse developmental outcome , but the individual lowest SVC flow was not , suggesting the importance of duration of low SVC flow . After adjustment , there was no significant association between average mean blood pressure over the first 24 hours and abnormal developmental outcome , whereas the proportion of mean blood pressure readings less than the gestational age showed a trend toward an association with death and any disability . CONCLUSIONS Low early postnatal blood flow to the upper body and brain may be one factor in the causal pathway of impaired preterm neurodevelopmental outcome Aim To study the effect of brief delay in cord clamping on short-term neurobehavioural outcome of preterm neonates . Methods All preterm neonates born between 34 - 36 weeks and 6 days were included and r and omized into either a control or intervention group . In the control group , clamping was done within 20 s after delivery , and this was termed as immediate cord clamping ( ICC ) . In the intervention group , delayed cord clamping ( DCC ) took place between 30 and 60 s. A total of 120 preterm neonates were enrolled . The primary outcome studied was short-term neurobehavioural outcome at 37 weeks after conceptional age using the Neurobehavioral Assessment of Preterm Infants ( NAPI ) score as the outcome measure . Results NAPI scores at 37 weeks of corrected gestational age revealed a mean ( 95 % confidence interval ) score of motor development and vigour of 64.21±27.31 ( 57.27 - 71.14 ) vs. 76.69±25.29 ( 70.04 - 83.34 ) , p = 0.01 ; and alertness and orientation of 29.31±12.78 ( 26.06 - 32.55 ) vs. 42.77±15.75 ( 38.63 - 46.91 ) , p = 0.00 across the ICC vs. DCC groups , respectively . Conclusion A brief delay of 30 - 60 s in cord clamping is beneficial in improving neurobehavioural outcome of late preterm infants 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 The criteria for a good trial are similar in many serious diseases : first and foremost , ask an ‘ important ’ question and , secondly , answer it ‘ reliably ’ . These two very general criteria ... suggest some surprisingly specific consequences for clinical trial design . Particularly , they can be used to suggest both the possibility and the desirability of large , simple r and omized trials of the effects on mortality of various widely practicable treatments for common conditions ( 1 ) WILLIAM TARNOW-MORDI , PROFESSOR , WINNER CENTRE , NHMRC CLINICAL TRIALS CENTRE , UNIVERSITY OF SYDNEY , AUSTRALIA , MELINDA CRUZ , MIRACLE BABIES FOUNDATION , CHIPPING NORTON , NSW , AUSTRALIA , JONATHAN M MORRIS , PROFESSOR KOLLING INSTITURE , ROYAL NORTH SHORE HOSPITAL , UNIVERSITY OF SYDNEY , AUSTRALIA AND BEN W MOL , PROFESSOR , ROBINSON INSTITUTE , UNIVERSITY OF ADELAIDE , AUSTRALIA ....................................................................................................................................................................... ‘ W must change community culture so that one of the first questions asked by pregnant women and their families is , “ Are there any r and omised trials we can join ? ” ’ Melinda Cruz , parent Background Delayed cord clamping at birth has shown to benefit neonates with increased placental transfusion leading to higher haemoglobin concentrations , additional iron stores and less anaemia later in infancy , higher red blood cell flow to vital organs and better cardiopulmonary adaptation . As iron deficiency in infants even without anaemia has been associated with impaired development , delayed cord clamping seems to benefit full term infants also in regions with a relatively low prevalence of iron deficiency anaemia . In Nepal , there is a high anaemia prevalence among children between 6 and 17 months ( 72–78 % ) . The objective of the proposed study is to evaluate the effects of delayed and early cord clamping on anaemia ( and haemoglobin level ) at 8 and 12 months , ferritin at 8 and 12 months , bilirubin at 2–3 days , admission to Neonatal Intensive Care Unit ( NICU ) or special care nursery , and development at 12 and 18–24 months of age . Methods / design A r and omized , controlled trial comparing delayed and early cord clamping will be implemented at Paropakar Maternity and Women ’s Hospital in Kathm and u , Nepal . Pregnant woman of gestational age 34–41 weeks who deliver vaginally will be included in the study . The interventions will consist of delayed clamping of the umbilical cord ( ≥180 s after delivery ) or early clamping of the umbilical cord ( ≤60 s ) . At 8 and 12 months of age , infant ’s iron status and developmental milestones will be measured . Discussion This trial is important to perform because , although strong indications for the beneficial effect of delayed cord clamping on anaemia at 8 to 12 months of age exist , it has not yet been evaluated by a r and omized trial in this setting . The proposed study will analyse both outcome as well as safety effects . Additionally , the results may not only contribute to practice in Nepal , but also to the global community , in particular to other low-income countries with a high prevalence of iron deficiency anaemia . Trial registration Clinical trial.gov NCT02222805 . Registered August 19 2014 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 the procedure at caesarean section deliveries and it should be performed whenever possible . It reduces the need for packed red cell transfusions during the first 6 weeks of life In December 2012 , the American College of Obstetricians and Gynecologists published a Committee Opinion entitled " Timing of umbilical cord clamping after birth . " It stated that " evidence exists to support delayed cord clamping in preterm infants , when feasible . The single most important benefit for preterm infants is the possibility for a nearly 50 % reduction in IVH . " However , the Committee Opinion added that the ideal timing of umbilical cord clamping has yet to be determined and recommended that large clinical trials be conducted in the most preterm infants . Published r and omized controlled trials include < 200 infants of < 30 weeks ' gestation , with assessment s of neurodevelopmental outcome in less than one-half of the children . This is a major gap in the evidence . Without reliable data from r and omized controlled trials that optimally include childhood follow-up evaluations , we will not know whether delayed cord clamping may do more overall harm than good . Ongoing trials of delayed cord clamping plan to report childhood outcomes in > 2000 additional very preterm infants . Current recommendations may need to change when these results become available . Greater international collaboration could accelerate resolution of whether this promising intervention will improve disability-free survival in about 1 million infants who will be born very preterm globally each year Background There are two approaches to care during the third stage of labour : Active management includes three components : administration of a prophylactic uterotonic drug , cord clamping and controlled cord traction . For physiological care , intervention occurs only if there is clinical need . Evidence to guide care during the third stage is limited and there is variation in recommendations which may contribute to differences in practice . This paper describes current UK practice during the third stage of labour . Methods A postal survey of 2230 fellows and members of the Royal College of Obstetricians and Gynaecologists ( RCOG ) and 2400 members of the Royal College of Midwives was undertaken . Respondents were asked about care during the third stage of labour , for vaginal and caesarean births and their views on the need for more evidence to guide care in the third stage . The data were analysed in Excel and presented as descriptive statistics . Results 1189 ( 53 % ) fellows and members of the RCOG and 1702 ( 71 % ) midwives responded , of whom 926 ( 78 % ) and 1297 ( 76 % ) 
    Output:
    
: This systematic review provides high‐ quality evidence that delayed clamping  reduced hospital mortality , which supports current guidelines recommending delayed clamping in preterm infants .