neonates born before 34 weeks (12 RCTs, N52,078). Delayed cord clamping was up to three minutes but was typically between 30 and 60 seconds. Primary outcomes included any IVH, severe IVH (grade 3 or 4 diagnosed by ultrasound), infant periventricular leukomalacia, infant chronic lung disease, and maternal blood loss greater than 500 mL. Delayed cord clamping compared with early cord clamping was associated with a 17% relative risk (RR) reduction in any IVH (15 RCTs, N52,333; RR 0.83; 95% CI, 0.70-0.99; NNT532) but did not decrease the risk of severe IVH (10 RCTs, N52,058; RR 0.94; 95% CI, 0.63-1.4).No increase was observed in potential harms to the infant with delayed versus early cord clamping including the risk of periventricular leukomalacia (4 RCTs, N51,544, RR 0.58; 95% CI, 0.26-1.3) and chronic lung disease (6 RCTs, N51,644; RR 1.0, 95% CI, 0.94-1.1), and no difference was observed in maternal blood loss greater than 500 mL (2 RCT, N5180; RR 1.1; 95% CI, 0.07-17.6). Most of the studies were small with unclear risk of bias in the domains of selection bias, detection bias, and reporting bias.A 2021 systematic review and network metaanalysis identified 25 RCTs (N53,316) directly comparing the effectiveness of delayed (30-180 seconds) versus immediate (,30 seconds) umbilical cord clamping for the prevention of IVH in preterm infants 2 . Sixteen trials were also in the previously mentioned meta-analysis 1 . Neonates were born before 37 weeks' gestation or had a birthweight less than 2,500 g. The review analyzed IVH and severe IVH (grade 3 or 4) as secondary outcomes. In network meta-analysis, delayed cord clamping was associated with a lower odds of IVH compared with immediate cord clamping (17.8% vs 15.4%, respectively; odds ratio [OR] 0.73; 95% credible interval [CrI], 0.54-0.97; NNT542); however, no difference was noted in severe IVH (15 RCTs, N52,469; OR 0.83; 95% CrI, 0.47-1.3) except among infants born younger than 29 weeks' gestation (1 RCT, n537; OR 0.18; 95% CrI, 0.03-0.99). The major limitation was only 39% of the studies had overall low risk of bias and that potential harms were not evaluated.A 2020 ACOG Committee Opinion consensusbased guideline recommended delaying cord clamping for at least 30 to 60 seconds after birth in preterm infants (no recommendation rating given) 3 . The recommendation was based on a systemic review of 15 RCTs demonstrating lower risk of IVH with delayed versus immediate umbilical cord clamping in infants born between 24 and 36 weeks' gestation.