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Short, medium, and ...
Short, medium, and long deferral of umbilical cord clamping compared with umbilical cord milking and immediate clamping at preterm birth: a systematic review and network meta-analysis with individual participant data.
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- Seidler, Anna Lene (author)
- University of Sydney
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- Libesman, Sol (author)
- University of Sydney
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- Hunter, Kylie E (author)
- University of Sydney
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- Barba, Angie (author)
- University of Sydney
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- Aberoumand, Mason (author)
- University of Sydney
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- Williams, Jonathan G (author)
- University of Sydney
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- Shrestha, Nipun (author)
- University of Sydney
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- Aagerup, Jannik (author)
- University of Sydney
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- Sotiropoulos, James X (author)
- University of Sydney
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- Montgomery, Alan A (author)
- University of Nottingham
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- Gyte, Gillian M L (author)
- National Childbirth Trust
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- Duley, Lelia (author)
- University of Nottingham
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- Askie, Lisa M (author)
- University of Sydney
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- KC, Ashish, 1982 (author)
- Gothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för samhällsmedicin och folkhälsa,Institute of Medicine, School of Public Health and Community Medicine
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- Andersson, Ola (creator_code:cre_t)
- Lund University,Lunds universitet,Pediatrik, Lund,Sektion V,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Neonatologi,Forskargrupper vid Lunds universitet,Paediatrics (Lund),Section V,Department of Clinical Sciences, Lund,Faculty of Medicine,Neonatology,Lund University Research Groups
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(creator_code:org_t)
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- 2023
- 2023
- English.
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In: Lancet (London, England). - 1474-547X. ; 402:10418, s. 2223-2234
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Abstract
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- Deferred (also known as delayed) cord clamping can improve survival of infants born preterm (before 37 weeks of gestation), but the optimal duration of deferral remains unclear. We conducted a systematic review and individual participant data network meta-analysis with the aim of comparing the effectiveness of umbilical cord clamping strategies with different timings of clamping or with cord milking for preterm infants.We searched medical databases and trial registries from inception until Feb 24, 2022 (updated June 6, 2023) for randomised controlled trials comparing cord clamping strategies for preterm infants. Individual participant data were harmonised and assessed for risk of bias and quality. Interventions were grouped into immediate clamping, short deferral (≥15 s to <45 s), medium deferral (≥45 s to <120 s), long deferral (≥120 s), and intact cord milking. The primary outcome was death before hospital discharge. We calculated one-stage, intention-to-treat Bayesian random-effects individual participant data network meta-analysis. This study was registered with PROSPERO, CRD42019136640.We included individual participant data from 47 trials with 6094 participants. Of all interventions, long deferral reduced death before discharge the most (compared with immediate clamping; odds ratio 0·31 [95% credibility interval] 0·11-0·80; moderate certainty). The risk of bias was low for 10 (33%) of 30 trials, 14 (47%) had some concerns, and 6 (20%) were rated as having a high risk of bias. Heterogeneity was low, with no indication of inconsistency.This study found that long deferral of clamping leads to reduced odds of death before discharge in preterm infants. In infants assessed as requiring immediate resuscitation, this finding might only be generalisable if there are provisions for such care with the cord intact. These results are based on thoroughly cleaned and checked individual participant data and can inform future guidelines and practice.Australian National Health and Medical Research Council.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Pediatrik (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Pediatrics (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Hälsovetenskap -- Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Health Sciences -- Public Health, Global Health, Social Medicine and Epidemiology (hsv//eng)
Keyword
- Infant
- Pregnancy
- Female
- Infant
- Newborn
- Humans
- Infant
- Premature
- Premature Birth
- prevention & control
- Umbilical Cord Clamping
- Constriction
- Bayes Theorem
- Network Meta-Analysis
- Umbilical Cord
- Time Factors
- Australia
Publication and Content Type
- ref (subject category)
- for (subject category)
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To the university's database
- By the author/editor
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Seidler, Anna Le ...
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Libesman, Sol
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Hunter, Kylie E
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Barba, Angie
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Aberoumand, Maso ...
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Williams, Jonath ...
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show more...
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Shrestha, Nipun
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Aagerup, Jannik
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Sotiropoulos, Ja ...
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Montgomery, Alan ...
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Gyte, Gillian M ...
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Duley, Lelia
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Askie, Lisa M
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KC, Ashish, 1982
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Andersson, Ola
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show less...
- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Pediatrics
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Health Sciences
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and Public Health Gl ...
- Articles in the publication
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Lancet (London, ...
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The Lancet
- By the university
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University of Gothenburg
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Lund University