Delayed Versus Immediate Cord Clamping in Preterm Birth

The goal of this study is to evaluate whether delayed cord clamping improves early neonatal outcomes compared with immediate clamping in preterm birth. Preterm infants are at higher risk of neonatal complications, and the timing of cord clamping may influence placental transfusion and neonatal adaptation after birth. Delayed cord clamping may increase blood volume, improve iron stores, and reduce some neonatal morbidities, while immediate cord clamping is still commonly practiced in many settings. In this study, preterm newborns are assigned to either delayed or immediate cord clamping according to a predefined protocol. Early neonatal outcomes, including respiratory status, need for resuscitation, hemoglobin levels, and early morbidity and mortality, will be assessed. The study is conducted in a tertiary maternity center in Tunisia.

Inclusion Criteria: * Preterm neonates born at gestational age between 32 and 37 weeks * Live-born infants delivered in the study center * Singleton pregnancies * Parental consent obtained when applicable according to institutional ethical requirements Exclusion Criteria: * Major congenital malformations or chromosomal abnormalities * Need for immediate advanced resuscitation at birth * Severe fetal distress requiring emergency obstetric intervention incompatible with protocol allocation * Placental conditions contraindicating delayed cord clamping (e.g., placental abruption with maternal instability, placenta previa bleeding, Placenta accreta spectrum) * Intra Uterin Growth Restriction with abnormal umbilical artery Doppler velocimetry