Our findings indicated that delaying cord clamping after 60 s increased haematocrit after 72 h of life born by ECS, without influencing the SpO
2, HR, T and phototherapy. The placental transfusion by DCC gives to baby about 80–100 ml of blood additional and 20–30 mg of iron [
15], this determines a great haemoglobin concentration in the newborns and best iron storage between 3 and 6 months of life and less incidence for transfusion and neonatal hypotension [
6‐
9,
16]. Experimental studies, executed on animals and humans, analysed cardiocirculatory changes in the foetus immediately after birth and the importance of the DCC for the hemodynamic stabilization, particularly in the lowest gestational age Delayed cord clamping alters acid-base parameters and lactate values compared to immediate cord clamping [
2,
3].. The timing of cord clamping was 180 s or longer demonstrating neurodevelopmental benefits in low-risk populations [
17,
18]. DCC after one minute is a practice that has been shown to be beneficial in spontaneous births [
19‐
21]. The infants born by ECS showed a lower value of red blood cells than those birth by VD. The factors that affect placental transfusion appear to be uterine contractility. CS reduces placental transfusion due to maternal hypotension and insufficient uterine contractions [
11‐
22]. Such reduction is even more pronounced by ECS than in emergency CS [
11]. No differences in maternal bleeding complications were found with DCC in multiple pregnancies compared to ICC. DCC can be done safely in multiple pregnancies without any increased of maternal risk [
23]. DCC is not possible without the parents’ informed consent because this practice can alter the procedure to donation and collection of umbilical cord blood. Indeed, umbilical cord must be clamped and severed immediately to proceed with collection successfully. Our study evaluated whether the benefits that the DCC presented in the spontaneous births occur also for those born at term by ECS. Our data suggested that DCC was associated with an increase in haematocrit and bilirubin estimated at 72 h after birth. Although DCC was associated in a study [
24] with an increase in phototherapy, in our study capillary bilirubin values were higher in the DCC group compared to the ICC group but without the need for phototherapy. Furthermore, no difference in statistical significance was found in HR and SpO
2 between groups. These data were recorded in the first and 5th minute from birth. Wafaa at al. found greater values of SpO
2 between newborns subjected to DCC compared to those treated by ICC, immediately after the birth. However, at 6 h of life the difference was no longer found [
4]. Yu L et al. did not consider the evaluation of SpO
2 and HR in DCC group but considered as primary outcomes mortality, risk of iron-deficiency anaemia [
20]. Similarly, Nevill at al. did not analyse oxygen saturation at birth but assessed the need for oxygen support which resulted lower in the group with DCC compared to ICC [
9]. A large trial on 1510 newborns born by VD and randomized in DCC or ICC group reported higher values of SpO2 and lower value of HR at 1 and 5 min in DCC group with respect to IC [
25]. These results encourage the use of DCC also in the newborns born by ECS as a valid tool to obtain a smoother cardiopulmonary transition. In our study although no statistical difference was found in HR and SpO2 although infants in the DCC group showed higher pre-ductal saturation values and lower HR values than those in the ICC group. This means that it is probably necessary to conduct a study in a larger sample size of newborns born by ECS to reveal a statistical difference between these variables. Finally, the temperature was evaluated for the potential heat loss during DCC. Data showed no clinically relevant temperature difference at the time of admission to the nursery between two arms, according to a recent systematic review [
26]. The temperature variable was assessed in 11 trials involving 2317 preterm infants. Although there was moderate heterogeneity between studies a reduction of temperature in the group with DCC was not observed [
26]. The strengths of our study included study design and attention for newborns born by ECS, however we investigated only the short-term outcome. It could be interesting to carry out studies about long-term outcomes such as iron concentration and neurodevelopment in childhood.