Starting respiratory support prior to cord clamping in preterm infants to improve pulmonary en circulatory transition immediately after birth: effectivenss study.

Experimental studies have shown that assuring lung aeration and ventilation before cord clamping results in more stable cardiovascular transition at birth. Our newly designed resuscitation table, the Concord, allows to delay cord clamping in preterm infants until the infant is stabilised; an approach considered as Physiological-Based Cord Clamping (PBCC). Feasibility of PBCC with the Concord has been tested and confirmed. In this study our objective is to test whether stabilisation of preterm infants (24 - 31 weeks) performing PBCC using the Concord is at least as effective when compared to the standard approach using the standard resuscitation table. We wil perform a multicenter randomized controlled non-inferiority trial and the primary outcome will be the time needed to stabilize the infant, starting from birth.

Stabilisation of preterm infants performing physioloigcal based cord clamping using the Concord is at least as effective as stabilisation according to the standard approach using the standard resusciation table.

The intervention is immediately after at birth and restricted to PBCC or regular support of transition. All other clinical care is according to standard local protocols with no difference between the intervention and control group.

Preterm infants randomized to the intervention group will be stabilized according to physioloigcal based coord clamping (PBCC). As soon as the infant is born, the infant will be placed on the Concord (a purpose-built resusciation table) and respiratory support will be started according to the local resuscitation guidelines. The umbilical cord will not be clamped until the infant is stabilised, defined as the establishment of regular spontaneous breathing evaluated on the respiratory function monitor, a heart rate ¡Ý 100 bpm and oxygen saturation above 90% while using FiO2 < 0.40.

Preterm infants randomized to the control group will receive delayed cord clamping (DCC) for 30-60 seconds and will be subsequently stabilised according to standard local resusciation guidelines on a regular resuscitation table.