A recently published randomized clinical trial¹ from researchers in California has found that giving 100% oxygen to extremely preterm infants during deferred cord clamping (DCC) significantly reduces the risk of early hypoxemia (low blood oxygen levels) without increasing harm.

Why Is this important?

Deferred cord clamping has become a key part of neonatal care for preterm babies, improving blood volume and circulation during a critical window just after birth. However, many infants still experience dangerously low oxygen levels. A review of recent extremely preterm neonate data from California neonatal intensive care units² that begin resuscitation with 30% oxygen demonstrated that infants with hypoxia (defined as a 5-minute saturation of peripheral oxygen [SpO2] <80%) was independently associated with increased risks of death and / or severe intraventricular hemorrhage (IVH). The aim of this study was explore whether providing higher levels of oxygen during DCC in extremely premature babies could safely address this problem.

What Was Studied

Between November 2021 and October 2024, 140 infants born between 22 and 28 weeks’ gestational age were enrolled across three California hospitals. All infants received breathing support via face mask during DCC (CPAP or Positive Pressure Ventilation) and were randomly assigned to receive either:

• 30% oxygen (standard care), or
• 100% oxygen (high oxygen group)

After cord clamping, all babies were treated using standard resuscitation guidelines.

Key Findings

• 69% of babies in the 100% oxygen group reached safe oxygen saturation levels (80%) by five minutes after birth, compared to just 39% in the 30% oxygen group.
• The high oxygen group had a 30% lower risk of early hypoxemia.
• There was no increase in adverse outcomes, such as brain injury (intraventricular hemorrhage) or early death, in the high oxygen group.

What’s Next

The results are promising and suggest that higher concentration oxygen provision during DCC could offer safer transitions for pre-term infants. However, the researchers emphasize that larger trials are needed to confirm long-term benefits and assess any potential risks over time.

SurePulse

These research findings are of particular interest to SurePulse who’s vision is a world where baby-centred innovation transforms neonatal outcomes. SurePulse is developing a wireless, multi-parameter monitoring device, which has the potential to be used straight after birth, even during delayed cord clamping, to provide Clinicians with quick and accurate vital signs information to inform treatment decisions.

References

1. Katheria AC, Ines F, Lee HC, Sollinger C, Vali P, Morales A, Sanjay S, Dorner R, Koo J, Gollin Y, Das A, Poeltler D, Steinhorn R, Finer N, Lakshminrusimha S. Deferred Cord Clamping With High Oxygen in Extremely Preterm Infants: A Randomized Clinical Trial. JAMA Pediatr. 2025 Jul 21:e252128. doi: 10.1001/jamapediatrics.2025.2128. Epub ahead of print. PMID: 40690234; PMCID: PMC12281397.
2.  Jiang, S., Cui, X., Katheria, A. et al. Association between 5-minute oxygen saturation and neonatal death and intraventricular hemorrhage among extremely preterm infants. J Perinatol (2024). https://doi.org/10.1038/s41372-024-02194-w