New insights from the ABC3 trial: Experience with PBCC is associated with higher intact survival

A newly published post-hoc analysis of the ABC3 trial, conducted across all ten participating Dutch NICU centres, shows that centres with experience in physiological-based cord clamping (PBCC) achieved a 13% higher intact survival compared with time-based cord clamping (TBCC of 30–60 seconds). This higher intact survival was largely explained by lower infant mortality.

The findings provide valuable insights into the importance of training, experience and procedural familiarity to achieve the full potential of PBCC, similar to many other medical interventions. The authors suggest that improved outcomes likely resulted from a combination of repeated training, structured team reflection, accumulated hands-on experience and increased patient exposure over time.

The study highlights that the benefits of PBCC may become more apparent as teams move beyond the initial learning phase. A gradual introduction, for example starting with term infants or more stable preterm infants, may support safer and more effective adoption and help centers achieving optimal outcomes.

These findings add to the growing body of evidence and align with its inclusion in the recently published ERC Newborn Life Support guidelines. Together, they suggest that PBCC has the potential to evolve into a new standard of care when implemented with appropriate experience and team coordination.

At Concord Neonatal, we work closely with clinical teams to support the safe, effective and sustainable implementation of PBCC. Beyond providing the Concord Birth Trolley, we focus on training, workflow integration and team-based implementation, recognizing that experience and familiarity are key to achieving optimal outcomes. We invite clinical teams exploring PBCC to join a growing community, learn from shared experience, and take the next step toward implementing PBCC in their own setting, because every baby deserves the best possible support, close to mom, in the first minutes of life.

Link to the full-text open access publication in Resuscitation Journal