We appreciate the interest of Asfour et al.1 in our article.2 Although the issue of delayed cord clamping is still controversial because of the subsequent increased rate of fetal jaundice, we agree that it has major fetal benefits, mainly including the increase of fetal haemoglobin level in the first 6 months of life.3
Conversely, the effect of delayed cord clamping on fetal blood volume and subsequently on fetal total weight is yet to be studied. Asfour et al. quoted from an observational study, with a small sample size of 26 infants, that found placental autotransfusion after delayed cord clamping to possibly be responsible for one-quarter to one-third of the total fetal blood volume.4 We believe that large studies are needed to fully understand the relationship between delayed cord clamping and fetal blood volume, and ultimately fetal weight. In a randomised study by Catalina De Paco et al.5 neither newborns with delayed nor newborns with early cord clamping required admission to a neonatal intensive care unit (NICU).
In our study,2 the database (MOND) does not contain information on the timing of cord clamping for any of the 20 938 cases, and thus could not have been implemented in our analysis. The consensus in our department, however, is to allow at least 30 seconds of pumping before clamping the cord. Hence, we don’t think that the cord clamping time would have a significant effect on NICU admissions.