Rationale

In premature infants, physiological-based cord clamping (PBCC; clamping after lung aeration), may allow a smoother cardiopulmonary transition than time-based cord clamping (TBCC; clamping after 30-60 s). However, in infants affected by antenatal inflammation of the fetal membranes (histological chorioamnionitis; HCA) and umbilical vessels (funisitis/funiculitis/fetal response; FUN), PBCC could prolong exposure to inflammatory mediators that suppress breathing. We therefore investigated how HCA ± FUN affects breathing effort of PBCC infants.

Methods

Infants born <30 weeks' gestation at the Leiden University Medical Centre, enrolled in the ABC3 trial (2019-2022) comparing PBCC and TBCC, with placental examination and respiratory function monitor recordings were categorised into four groups (with/without HCA ± FUN receiving PBCC/TBCC). Primary outcome was breathing effort, defined as minute volume of spontaneous breathing in the first 1-5 min. We also assessed additional physiological outcomes. Regression models tested the effects of HCA ± FUN on breathing effort in PBCC infants.

Results

Eighty-three infants were included: 44 infants with HCA ± FUN (17 PBCC, 27 TBCC) and 39 infants without HCA ± FUN (13 PBCC, 26 TBCC). Baseline characteristics were similar between PBCC and TBCC infants with/without HCA ± FUN. Regression analyses demonstrated that the effect of HCA ± FUN on average minute volume (mL/kg/min; p = 0.507), tidal volume (mL/kg/breath; p = 0.751) and respiratory rate (breaths/min; p = 0.559) was not different between PBCC and TBCC infants. However, in infants with HCA ± FUN, PBCC infants had sustained lower tidal volume compared with TBCC infants, while in infants without HCA ± FUN, PBCC infants reached similar levels as TBCC infants.

Conclusion

HCA ± FUN may not differentially affect neonatal breathing effort in premature infants stabilised with PBCC, although increases in tidal volume may be moderated.

Copyright © 2026. Published by Elsevier B.V.