Delayed cord clamping in neonates: A global evidence-based review of physiology, outcomes, and clinical integration in term and preterm births

Delayed cord clamping (DCC) has emerged as a transformative intervention in neonatal care, shifting long-standing practices rooted in tradition rather than evidence. Once considered a procedural detail, the timing of umbilical cord clamping is now recognized as a crucial determinant of neonatal outcomes. DCC, typically defined as clamping the cord ≥30–60 s after birth or after cessation of pulsation, has demonstrated measurable benefits in both term and preterm infants, including improved iron status, enhanced cardiovascular stability, and reduced need for transfusion. This comprehensive narrative review evaluates the physiological basis, clinical outcomes, and implementation strategies surrounding DCC. Drawing from over a decade of literature, the review synthesizes findings from randomized trials, observational studies, and international guidelines. Specific emphasis is placed on the distinct effects of DCC in term versus preterm neonates, with further attention to cord milking, physiologic-based cord clamping, and special scenarios such as cesarean sections or neonatal resuscitation. Barriers to adoption in both high-resource and low-resource settings are examined, including logistical challenges, clinical hesitations, and policy gaps. Evidence consistently supports that DCC improves neonatal hematologic parameters, decreases intraventricular hemorrhage in preterms, and does not increase maternal risk. Nonetheless, variability in practice persists globally. This review highlights consensus points across the World Health Organization, American College of Obstetricians and Gynecologists, Royal College of Obstetricians and Gynecologists, and National Institute for Health and Care Excellence guidelines, while identifying inconsistencies and areas of needed harmonization. A practical framework for implementation and clinical decision-making is proposed. To realize the full potential of DCC, health systems must integrate evidence into training, protocols, and delivery room infrastructure. Future research must refine timing strategies, assess long-term neurodevelopmental outcomes, and evaluate adjunct techniques such as cord milking. This article aims to be a reference standard that bridges knowledge to practice, advocating for a unified, evidence-informed approach to neonatal transition.