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Intact-cord resuscitation improved a composite neonatal outcome in one very-preterm trial

European journal of pediatrics (PubMed)Aug 12, 2026

AI-summarized from the linked source. Educational brief, not medical advice.

Brief summary

In a single-center randomized trial of 127 very preterm neonates needing delivery-room resuscitation, intact-cord resuscitation was associated with fewer composite events of in-hospital death, severe intraventricular hemorrhage, or bronchopulmonary dysplasia than conventional clamping.

What NurseJet pulled from the source

The open-label trial compared resuscitation with the cord intact until physiological placental expulsion with clamping within 30 to 60 seconds. The composite outcome occurred in 35.9% versus 60.3% of per-protocol participants, but the small single-center design means the strategy requires confirmation and protocol-level implementation rather than bedside extrapolation.

Why this matters for nurses

Neonatal and pediatric nurses coordinate thermal support, ventilation, oxygenation, monitoring, and team communication during stabilization of very preterm infants. The trial offers a clinically important signal while emphasizing that intact-cord resuscitation depends on a prepared multidisciplinary delivery-room pathway.

Bedside takeaway

Intact-cord resuscitation for very preterm infants requires a coordinated, protocol-defined delivery-room setup and further confirmation of benefit.

How This Applies in Practice

Use this when: Preparing for the delivery-room stabilization of a very preterm infant when an intact-cord resuscitation pathway is available.

On your shift

Confirm the cord-management plan, eligible gestational range, equipment placement, warming strategy, monitoring setup, and assigned obstetric and neonatal roles during the pre-delivery briefing.
Document cord-clamping timing, respiratory support, oxygenation, heart rate, temperature, and transition events using the neonatal resuscitation record.
Escalate equipment, access, maternal, or neonatal concerns that make the planned pathway unsafe or infeasible before or during stabilization.

Keep in mind: The evidence comes from one small center and does not establish a universal cord strategy. Follow the neonatal resuscitation protocol, facility policy, and provider orders.

Key takeaways

The per-protocol analysis included 127 neonates born at 26 weeks 0 days through 31 weeks 6 days who required delivery-room resuscitation.
The composite of in-hospital mortality, severe intraventricular hemorrhage, or bronchopulmonary dysplasia occurred in 35.9% with intact-cord resuscitation and 60.3% with conventional clamping.
Mortality was 26.6% versus 41.3%, and severe intraventricular hemorrhage was 9.4% versus 20.6%, respectively.
Maternal safety outcomes were comparable between groups in this trial.

Practice implications

For an anticipated very preterm birth, confirm the ordered cord-management and resuscitation plan, equipment position, role assignments, monitoring, and escalation route before delivery. Document timing, respiratory support, oxygenation, temperature, and transition findings according to the neonatal pathway.

Limitations & cautions

This was a single-center, open-label trial with 127 neonates and a per-protocol analysis. The composite combined outcomes of different clinical importance, and the findings may not generalize to centers without the same equipment, staffing, obstetric coordination, or neonatal population.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations

Exact source links

Open source

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European journal of pediatrics (PubMed)

European journal of pediatrics (PubMed). Effect of intact cord resuscitation versus conventional cord clamping on clinical outcomes in very preterm neonates: a randomized controlled trial from Eastern India.

Open original source

https://pubmed.ncbi.nlm.nih.gov/42584505/

Professional education only

This summary does not replace clinical judgment, facility policy, provider orders, or official guidelines. Verify practice changes against the original source and local protocol.

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Journal of midwifery & women's health (PubMed)Sep 7, 2026Research Article

A retrospective analysis of US natality data found no statistically significant yearly difference in neonatal mortality between freestanding birth centers and hospitals among term, singleton, vertex births without major medical risk factors from 2015 through 2024.

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Adjusted neonatal-mortality odds for freestanding birth centers fluctuated around 1.0 across the 10-year study period. No individual year showed a statistically significant difference from hospital births, including 2020 and 2021 when birth-center volume increased.

Key takeaways

The analysis was restricted to births meeting selected low-risk criteria.
The study found no evidence that higher birth-center use during the pandemic years increased neonatal mortality.
The observational design cannot establish that birth setting itself caused the mortality pattern.

Why this matters on shift

The findings add national outcome data for counseling and systems planning around freestanding birth-center care for appropriately selected low-risk pregnancies.

Bedside takeaway

Apply local eligibility, surveillance, escalation, and transfer protocols when caring for planned low-risk birth-center patients.

Nursing implications

Keep eligibility, surveillance, escalation, and transfer decisions anchored to local birth-center criteria and maternal-newborn protocols.

Limitations & cautions

Abstract-only summary. The study used retrospective vital-record data, was limited to selected low-risk births, and cannot exclude residual differences between people who delivered in birth centers and hospitals.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

Journal of midwifery & women's health (PubMed). Neonatal Mortality Risk Among Births in Freestanding Birth Centers, 2015 to 2024.

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AI-summarized from the linked source. Review the original article before applying to practice.

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A double-blind randomized trial found no reduction in vomiting or faster oral tolerance with intravenous pantoprazole versus placebo in children with acute gastroenteritis and persistent vomiting after ondansetron.

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The trial randomized 100 children. Vomiting episodes and oral tolerance at 6 and 12 hours did not differ significantly, while median hospital stay was 2 days with pantoprazole and 1 day with placebo.

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The median participant age was 14 months, and 67% of participants were male.
Oral tolerance at 12 hours was 86% in both groups.
The longer stay associated with pantoprazole requires cautious interpretation because this was a single-center trial.

Why this matters on shift

The trial does not support empiric intravenous proton-pump inhibition for persistent vomiting in pediatric acute gastroenteritis after ondansetron.

Bedside takeaway

Clarify the indication for empiric acid suppression and keep hydration and oral-tolerance assessment central to care.

Nursing implications

Prioritize the ordered hydration and oral-tolerance plan, document ongoing emesis, and clarify the indication before administering empiric acid suppression.

Limitations & cautions

Abstract-only summary. This was a single-center study of 100 children in Tehran, and the abstract does not describe adverse events or explain why hospitalization was longer in the pantoprazole group.
AI-summarized from the linked source. Review the original article before applying to practice.

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Pediatric emergency care (PubMed). Effect of Intravenous Pantoprazole on Clinical Outcomes in Pediatric Acute Gastroenteritis: A Placebo-Controlled RCT.

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The trial randomized 500 adults. Moderate-to-severe PACU pain occurred in 145 of 242 assessed participants in the fentanyl group and 138 of 233 in the dexmedetomidine group, with no significant difference.

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Intraoperative rescue fentanyl use did not differ significantly between groups.
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Other in-hospital outcomes were similar between the two regimens.

Why this matters on shift

An opioid-sparing label did not translate into better early pain control in this trial, and the differing hypotension and shivering profiles remain relevant during perioperative handoff and recovery monitoring.

Bedside takeaway

Monitor pain, hemodynamics, sedation, and shivering in relation to the analgesic regimen and local protocol.

Nursing implications

During PACU and postoperative handoff, monitor pain, hemodynamics, sedation, and shivering according to the administered regimen and local protocol.

Limitations & cautions

Abstract-only summary. The trial involved elective tumor craniotomy at five Indian centers, both groups also received locoregional analgesia, and the abstract does not provide longer-term outcome results in detail.
AI-summarized from the linked source. Review the original article before applying to practice.

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How This Applies in Practice

Key takeaways

Practice implications

Limitations & cautions

Exact source links

More updates for this clinical area

Low-risk birth-center births showed no higher neonatal mortality in a 10-year analysis

IV pantoprazole did not improve vomiting or oral tolerance in pediatric gastroenteritis

Dexmedetomidine did not improve early pain outcomes versus fentanyl for craniotomy