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
Date
2023
Authors
Seidler, A.L.
Libesman, S.
Hunter, K.E.
Barba, A.
Aberoumand, M.
Williams, J.G.
Shrestha, N.
Aagerup, J.
Sotiropoulos, J.X.
Montgomery, A.A.
Editors
Advisors
Journal Title
Journal ISSN
Volume Title
Type:
Journal article
Citation
The Lancet, 2023; 402(10418):2223-2234
Statement of Responsibility
Anna Lene Seidler, Sol Libesman, Kylie E Hunter, Angie Barba, Mason Aberoumand, Jonathan G Williams, Nipun Shrestha, Jannik Aagerup, James X Sotiropoulos, Alan A Montgomery, Gillian M L Gyte, Lelia Duley, Lisa M Askie, and iCOMP Collaborators
Conference Name
Abstract
Background 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. Methods 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 randomeffects individual participant data network meta-analysis. This study was registered with PROSPERO, CRD42019136640. Findings 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. Interpretation 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.
School/Discipline
Dissertation Note
Provenance
Description
Corrected by: Department of Error - 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, in Volume 402, Issue 10418 p2196 December 09, 2023. Figure 3C of this Article incorrectly showed the odds ratios and 95% credibility intervals of figure 3B. The figure has now been updated to show the correct values. This correction has been made as of Dec 7, 2023.
Access Status
Rights
© 2023 Elsevier Ltd. All rights reserved