Umbilical Cord Management at Term and Late Preterm Birth: A Meta-analysis

Abstract

CONTEXT: The International Liaison Committee on Resuscitation prioritized scientific review of umbilical cord management at term and late preterm birth. OBJECTIVE: To assess effects of umbilical cord management strategies (clamping timing and cord milking) in infants ≥34 weeks’ gestational age. DATA SOURCES: Cochrane Central Register of Controlled Trials, Medline, PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, and trial registries searched July 2019. STUDY SELECTION: Two authors independently assessed eligibility of randomized controlled trials. DATA EXTRACTION: Two authors independently extracted data and assessed evidence certainty (Grading of Recommendations Assessment, Development and Evaluations). RESULTS: We identified 46 studies (9159 women and their infants) investigating 7 comparisons. Compared with early cord clamping (ECC) <30 seconds, delayed cord clamping (DCC) ≥30 seconds (33 studies), intact-cord milking (1 study), and cut-cord milking (2 studies) probably improve hematologic measures but may not affect survival without neurodisability, anemia in early infancy, or maternal postpartum hemorrhage. No differences in major neonatal morbidities are seen in studies comparing methods of optimizing placental transfusion (DCC versus cut-cord milking [3 studies], longer delays in clamping [7 studies], or physiologic parameters [3 studies]). Strategies that promote increased placental transfusion may be associated with greater phototherapy use. Evidence for all outcomes was low or very low certainty. LIMITATIONS: Incompleteness and low certainty of findings limit applicability. CONCLUSIONS: Compared with ECC, DCC or cord milking increases hemoglobin and hematocrit immediately after birth in infants ≥34 weeks’ gestational age. The uncertain effects of DCC and cord milking compared with ECC on major morbidities limit usefulness of available evidence for policy and practice.

Versorgung und Reanimation des Neugeborenen nach der Geburt

“…Verzögertes Abnabeln wurde als Zeitraum ab 30 s nach der Geburt oder auch basierend auf physiologischen Parametern (z. B. nach einem Ende der Nabelschnurpulsationen oder nach dem Einsetzen einer Spontanatmung), exklusive eines Ausstreichens der Nabelschnur, definiert [ 92 , 93 ].…”

“…Für Frühgeborene und späte Frühgeborene („late preterms“) aktualisierte eine ILCOR-Metaanalyse von 33 Studien (5236 Neugeborene), die eine verzögerte Abnabelung mit einer sofortigen Abnabelung für diese Patientengruppe verglich, die Ergebnisse einer früheren Cochrane-Studie aus dem Jahr 2013 [ 93 , 105 ]. Die Analyse zeigte keinen signifikanten Effekt auf die Mortalität (RR 2,54; 95 %-CI 0,50 bis 12,74; 4 Studien, 537 Neugeborene) oder die Notwendigkeit für Reanimationsmaßnahmen (RR 5,08; 95 %-CI 0,25 bis 103,58; 3 Studien, 329 Neugeborene).…”

“…Aufgrund der begrenzten Datenlage sind derzeit keine Metaanalysen und damit keine Aussagen bezüglich des Ausstreichens der Nabelschnur bei reifen Neugeborenen und späten Frühgeborenen möglich [ 93 ].…”

Delivery Room Management of Asphyxiated Term and Near-Term Infants

“…Unfortunately, none of the included trials reported on the primary outcome of survival without moderate to severe neurodevelopmental impairment in early childhood. By randomizing vigorous term infants to immediate cord clamping versus umbilical cord milking or to delayed versus immediate umbilical cord clamping, no significant differences in neonatal outcomes (including Apgar scores, need for resuscitation, or admissions to the neonatal intensive care unit) were found [21]. Recently, updated SpO 2 and HR percentiles in term infants with delayed cord clamping were published [22].…”

Prematürede anemi ve transfüzyon politikaları

“…Doğum sonrası göbek kordonunun klemplenme zamanı veya kordun sağılmasıyla ilgili çalışmalarda; geç kord klemplemenin Htc ve serum ferritin düzeylerini arttırdığı, mortaliyeti ve İVK riskini azalttığı, kan transfüzyonunda %10 azalma sağladığı, ancak kord sağmanın aşırı prematüre (<28 gebelik haftası) bebeklerde ciddi İVK riskini arttırdığı, hatta bazı çalışmalarda RDS riskini arttıryor gözüktüğü belirtilmekte olup, prematüre bebeklerde ideal kord uygulama yönteminin halen net olarak ne olduğununu bilinmediği, ancak erken kord klemplemenin (<30 sn) prematüre bebeklerde zararlı olabileceği nedeniyle bu bebeklere erken kord klemplemenin önerilmemesi gerektiği bildirilmektedir [6,[33][34][35][36][37][38][39][40]. Kord sağma işlemi prematüre bebeklerde serebrovasküler ve sistemik kan akımında fluktuasyonlara neden olabileceği için şu an önerilmemektedir [10].…”