Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes
Top Cited Papers
- 15 August 2012
- journal article
- research article
- Published by Wiley in Emergencias
- No. 8,p. CD003248
- https://doi.org/10.1002/14651858.cd003248.pub3
Abstract
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. 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. 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. 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. Three review authors assessed eligibility and trial quality. 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. 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.Keywords
This publication has 38 references indexed in Scilit:
- Hemodynamic Effects of Delayed Cord Clamping in Premature InfantsPEDIATRICS, 2012
- Effects of delayed cord clamping in very-low-birth-weight infantsJournal of Perinatology, 2011
- Effects of delayed umbilical cord clamping on peripheral blood hematopoietic stem cells in premature neonatesjpme, 2011
- Seven-month developmental outcomes of very low birth weight infants enrolled in a randomized controlled trial of delayed versus immediate cord clampingJournal of Perinatology, 2009
- Immunologic and infectious consequences of immediate versus delayed umbilical cord clamping in premature infants: A prospective, randomized, controlled studyjpme, 2009
- A randomized clinical trial comparing immediate versus delayed clamping of the umbilical cord in preterm infants: short‐term clinical and laboratory endpointsTransfusion, 2008
- Immediate versus Delayed Umbilical Cord Clamping in Premature Neonates Born < 35 Weeks: A Prospective, Randomized, Controlled StudyAmerican Journal of Perinatology, 2007
- Delayed cord clamping in preterm infants delivered at 34–36 weeks’ gestation: a randomised controlled trialArchives of Disease in Childhood: Fetal & Neonatal, 2007
- Delayed Cord Clamping in Very Preterm Infants Reduces the Incidence of Intraventricular Hemorrhage and Late-Onset Sepsis: A Randomized, Controlled TrialPEDIATRICS, 2006
- A modified test for small‐study effects in meta‐analyses of controlled trials with binary endpointsStatistics in Medicine, 2005