Document Detail


Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes.
MedLine Citation:
PMID:  22895933     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Optimal timing for clamping the umbilical cord at preterm birth is unclear. Early clamping allows for immediate transfer of the infant to the neonatologist. Delaying clamping allows blood flow between the placenta, the umbilical cord and the baby to continue. The blood which transfers to the baby between birth and cord clamping is called placental transfusion. Placental transfusion may improve circulating volume at birth, which may in turn improve outcome for preterm infants.
OBJECTIVES: To assess the short- and long-term effects of early rather than delaying clamping or milking of the umbilical cord for infants born at less than 37 completed weeks' gestation, and their mothers.
SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group Trials Register (31 May 2011). We updated this search on 26 June 2012 and added the results to the awaiting classification section.
SELECTION CRITERIA: Randomised controlled trials comparing early with delayed clamping of the umbilical cord and other strategies to influence placental transfusion for births before 37 completed weeks' gestation.
DATA COLLECTION AND ANALYSIS: Three review authors assessed eligibility and trial quality.
MAIN RESULTS: Fifteen studies (738 infants) were eligible for inclusion. Participants were between 24 and 36 weeks' gestation at birth. The maximum delay in cord clamping was 180 seconds. Delaying cord clamping was associated with fewer infants requiring transfusions for anaemia (seven trials, 392 infants; risk ratio (RR) 0.61, 95% confidence interval (CI) 0.46 to 0.81), less intraventricular haemorrhage (ultrasound diagnosis all grades) 10 trials, 539 infants (RR 0.59, 95% CI 0.41 to 0.85) and lower risk for necrotising enterocolitis (five trials, 241 infants, RR 0.62, 95% CI 0.43 to 0.90) compared with immediate clamping. However, the peak bilirubin concentration was higher for infants allocated to delayed cord clamping compared with immediate clamping (seven trials, 320 infants, mean difference 15.01 mmol/L, 95% CI 5.62 to 24.40). For most other outcomes (including the primary outcomes infant death, severe (grade three to four) intraventricular haemorrhage and periventricular leukomalacia) there were no clear differences identified between groups; but for many there was incomplete reporting and wide CIs. Outcome after discharge from hospital was reported for one small study; there were no significant differences between the groups in mean Bayley II scores at age seven months (corrected for gestation at birth (58 children)).No studies reported outcomes for the women.
AUTHORS' CONCLUSIONS: Providing additional placental blood to the preterm baby by either delaying cord clamping for 30 to 120 seconds, rather than early clamping, seems to be associated with less need for transfusion, better circulatory stability, less intraventricular haemorrhage (all grades) and lower risk for necrotising enterocolitis. However, there were insufficient data for reliable conclusions about the comparative effects on any of the primary outcomes for this review.
Authors:
Heike Rabe; Jose Luis Diaz-Rossello; Lelia Duley; Therese Dowswell
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Publication Detail:
Type:  Journal Article; Meta-Analysis; Review     Date:  2012-08-15
Journal Detail:
Title:  The Cochrane database of systematic reviews     Volume:  8     ISSN:  1469-493X     ISO Abbreviation:  Cochrane Database Syst Rev     Publication Date:  2012  
Date Detail:
Created Date:  2012-08-16     Completed Date:  2012-09-26     Revised Date:  2013-06-28    
Medline Journal Info:
Nlm Unique ID:  100909747     Medline TA:  Cochrane Database Syst Rev     Country:  England    
Other Details:
Languages:  eng     Pagination:  CD003248     Citation Subset:  IM    
Affiliation:
BSMS Academic Department of Paediatrics, Brighton and Sussex University Hospitals, Royal Sussex Country Hospital, UK. heike.rabe@bsuh.nhs.uk
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MeSH Terms
Descriptor/Qualifier:
Blood Transfusion / utilization
Cerebral Hemorrhage / prevention & control
Female
Hematocrit
Humans
Infant, Newborn
Infant, Premature / blood
Ligation / standards
Placental Circulation / physiology*
Pregnancy
Premature Birth*
Randomized Controlled Trials as Topic
Respiration Disorders
Time Factors
Umbilical Cord*
Comments/Corrections
Update Of:
Cochrane Database Syst Rev. 2004;(4):CD003248   [PMID:  15495045 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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