To compare percentile values for cerebral oxygen saturation (crSO2) and fractional tissue oxygen extraction (FTOE) during the first 10 min of life in term neonates delivered by elective C-section, with either immediate (ICC) or deferred (DCC) cord clamping. Prospective, observational, single-center study including term neonates after uneventful pregnancies delivered by elective C-section. Exclusion criteria were emergency C-section, need for resuscitation, or congenital anomalies. Preductal pulse oximetry and near-infrared spectroscopy (NIRS) were used for continuous monitoring during the first 10 min. Percentile values for heart rate (HR), oxygen saturation (SpO2), crSO2, and FTOE were calculated, and the effect of cord clamping strategy was evaluated. A total of 242 neonates were included; 55 underwent DCC (median clamping time 60 s). All parameters changed significantly over time: HR increased by 4.22 beats/min per minute, SpO2 by 2.7% per minute, crSO2 by 4.99% per minute, while FTOE decreased by 1.04% per minute (all p < 0.01). No significant differences between ICC and DCC were found for crSO2 (β = –5.44, p = 0.12) or FTOE (β = –7.7, p = 0.12). Conclusions: Reference percentile curves for crSO₂ and FTOE are provided for term neonates delivered by elective C-section. Cerebral oxygen delivery and extraction showed stable trajectories during transition, independent of cord clamping strategy.<Table Float="No" ID="Taba"> <tgroup cols="1"> <colspec align="left" colname="c1" colnum="1" /> <tbody> <row> <entry align="left" colname="c1"> What is Known: • Cerebral regional tissue oxygen saturation (crSO2) and fractional tissue oxygen extraction (FTOE), assessed by near-infrared spectroscopy (NIRS), are accepted methods to monitor cerebral oxygenation and perfusion in neonates. However, reference values during the immediate postnatal transition are limited by a small sample size and a lack of stratification by cord clamping practice. </entry> </row> <row> <entry align="left" colname="c1"> What is New: • We present novel percentile reference curves for crSO2 and FTOE during the first 10 min of life in neonates born at term by elective cesarean section and subjected to immediate or delayed cord clamping. Cerebral oxygenation and extraction parameters remained stable independently of cord clamping timing, indicating effective cerebral autoregulation during fetal-to-neonatal transition. </entry> </row> </tbody> </tgroup> </Table>

Impact of delayed versus immediate cord clamping on cerebral oxygenation in neonates during postnatal stabilization

期刊论文
发表日期：

2026年4月27日

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Nerea Valles-Murcia,
Pilar Sáenz-González,
Susana Baixauli-Alacreu,
Raquel Escrig,
Marta Aguar Carrascosa,
María Cernada,
Berndt Urlesberger,
Máximo Vento,
Álvaro Solaz-García

摘要

To compare percentile values for cerebral oxygen saturation (crSO2) and fractional tissue oxygen extraction (FTOE) during the first 10 min of life in term neonates delivered by elective C-section, with either immediate (ICC) or deferred (DCC) cord clamping. Prospective, observational, single-center study including term neonates after uneventful pregnancies delivered by elective C-section. Exclusion criteria were emergency C-section, need for resuscitation, or congenital anomalies. Preductal pulse oximetry and near-infrared spectroscopy (NIRS) were used for continuous monitoring during the first 10 min. Percentile values for heart rate (HR), oxygen saturation (SpO2), crSO2, and FTOE were calculated, and the effect of cord clamping strategy was evaluated. A total of 242 neonates were included; 55 underwent DCC (median clamping time 60 s). All parameters changed significantly over time: HR increased by 4.22 beats/min per minute, SpO2 by 2.7% per minute, crSO2 by 4.99% per minute, while FTOE decreased by 1.04% per minute (all p < 0.01). No significant differences between ICC and DCC were found for crSO2 (β = –5.44, p = 0.12) or FTOE (β = –7.7, p = 0.12).

Conclusions: Reference percentile curves for crSO₂ and FTOE are provided for term neonates delivered by elective C-section. Cerebral oxygen delivery and extraction showed stable trajectories during transition, independent of cord clamping strategy.

What is Known:

• Cerebral regional tissue oxygen saturation (crSO2) and fractional tissue oxygen extraction (FTOE), assessed by near-infrared spectroscopy (NIRS), are accepted methods to monitor cerebral oxygenation and perfusion in neonates. However, reference values during the immediate postnatal transition are limited by a small sample size and a lack of stratification by cord clamping practice.

What is New:

• We present novel percentile reference curves for crSO2 and FTOE during the first 10 min of life in neonates born at term by elective cesarean section and subjected to immediate or delayed cord clamping. Cerebral oxygenation and extraction parameters remained stable independently of cord clamping timing, indicating effective cerebral autoregulation during fetal-to-neonatal transition.