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New ERC guidelines shift toward more physiological practices for umbilical cord management
Today, the European Resuscitation Council (ERC) published its updated Guidelines for Resuscitation 2025. The new guidelines recognize that, when possible, interventions for stabilizing the infant may take place close to the mother with the umbilical cord intact.
The overarching recommendation for umbilical cord management remains consistent: Ideally, delayed cord clamping should be performed in all births, after inflation of the lungs and before uterotonics are given.
For infants requiring support, the following recommendations are provided:
- Clamp the cord <30 s to minimize delay in interventions.
- If intact cord stabilization can be safely undertaken, longer DCC is preferred, especially in newborn infants below 34 weeks’ gestation.
The updated ERC Neonatal Life Support (NLS) guidelines mark a shift toward more physiological practices in umbilical cord management. For the first time, the guidelines specifically define Physiological Based Cord Clamping (PBCC):
“PBCC is not based on time, but on physiological parameters (i.e. when breathing has been initiated). When possible, interventions for stabilizing the infant may take place close to the mother with intact cord.”
These new guidelines reflect a shift toward care that keeps mother and baby connected after birth, a principle embraced by hospitals across Europe that have pioneered stabilization with the cord intact, by using the Concord Birth Trolley, designed to make this possible safely and effectively.