Sustained cord circulation at emergency cesarean section – a new concept for resuscitating neonates

The purpose of the SUCCECS study is to improve neonatal health and survival after emergency Cesarean section.

We aim to perform a multicenter study to evaluate a new approach to resuscitation of non-breathing neonates born by Cesarean section.

Study design: Multicenter study with stepped wedge cluster randomization.- Population: Singleton term neonates born by emergency Cesarean section.- Intervention: When in need of life support, the neonate will be put on a platform with the cord intact, close to the mother. The neonatal team will give respiratory support with sustained cord circulation, following neonatal CPR guidelines.

Cord clamping will be performed after respiration has been established and at the earliest after three minutes.- Control: Management according to standard care, including immediate cord clamping.- Outcome: Composite outcome of admission to neonatal care for predefined criteria (asphyxia at birth, respiratory distress, hypoxic-ischemic encephalopathy, hypoglycemia) and death before admission.

Short and long-term neonatal outcomes and adverse maternal and neonatal outcomes will be evaluated.Importance: A reduction in neonatal admissions can benefit both the neonate and their parents, while also yielding positive economic implications for healthcare systems.Time plan: Preparations started in 2022, supported by the SRC planning grant no. 2021-06581.

Training of staff will begin in early 2025, while the initial intervention rollout is planned for 2025.