The newborn and newborn life support: DipIMC practice questions

Answer: C

Delay clamping for at least 60 seconds and until after lung inflation

Resuscitation Council UK Guidelines 2025 say that, ideally, delayed cord clamping is performed in all births, for at least 60 seconds and after inflation of the lungs; newborn infants who need no support should have at least 60 seconds of delayed clamping, and longer may be beneficial. It applies to term babies as much as preterm ones, so restricting it to babies under 32 weeks is wrong. Clamping within 30 seconds is reserved for the baby who needs resuscitation that cannot be given with the cord intact, which is not this vigorous crying baby, and immediate clamping to move the baby to a flat surface gives up placental transfusion for convenience. Cord milking is not recommended below 28 weeks and, at or above 28 weeks, is only an alternative when delayed clamping cannot be done. Thermal care, drying and assessment go on during the delay. The ABC of Prehospital Emergency Medicine (2013) describes cutting the cord after it has stopped pulsating; the stem names the current UK guideline.

Answer: A

Clamp the cord within 30 seconds and start resuscitation, without milking

For newborn infants in need of resuscitation, Guidelines 2025 advise minimising any delay to necessary interventions and, if necessary, clamping the cord within 30 seconds; longer delayed clamping is preferred only if stabilisation with an intact cord can be safely undertaken, which the stem rules out. The guideline says not to milk the cord in preterm infants below 28 weeks; cord milking may be considered as an alternative at 28 weeks or more, but only if delayed cord clamping cannot be performed, and the key points note that cut-cord milking is a reasonable alternative only above 28 weeks. That is why both milking options are tempting and both are wrong at 26 weeks. At least 60 seconds of delayed clamping is the recommendation for infants who do not need support. Transporting before resuscitating delays lung inflation.

Answer: D

Do not dry the body, bag it in polyethylene, dry the head, add a hat; aim for 36.5 to 37.5 degrees C

Guidelines 2025 set the thermal target for newborn infants at 36.5 °C to 37.5 °C and say to avoid hyperthermia as well as hypothermia, so a target above 37.5 °C is wrong. For infants below 32 weeks, dry the head and cover it with a hat, and put the body in a plastic (polyethene) bag or wrap without drying. Drying the body and wrapping it in dry towels with a hat is the technique for infants of 32 weeks or more, and will lose heat from a very preterm baby; leaving the head bare forfeits the hat, and a heat pack against the skin is not part of the guidance. The guideline also advises keeping the delivery area at 23–25 °C for infants above 28 weeks (above 25 °C at 28 weeks or less), so warm the ambulance compartment.