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Systematic review and network meta-analysis with individual participant data on cord management at preterm birth
Anna Lene Seidler1, Lelia Duley2, Anup C Katheria3
1NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia lene.seidler@ctc.usyd.edu.au.
BMJ Open
|April 2, 2020
Summary
Cord management strategies like delayed clamping and cord milking can improve preterm infant outcomes. This study analyzes individual participant data to compare these methods and identify benefits across different preterm subgroups.
Area of Science:
- Neonatal Medicine
- Perinatal Research
- Evidence Synthesis
Background:
- Optimal cord management strategies are crucial for improving outcomes in preterm infants.
- Existing trials compare various methods, including delayed cord clamping and cord milking, but subgroup-specific benefits remain unclear.
Purpose of the Study:
- To evaluate the effectiveness of different cord management strategies on neonatal mortality and morbidity in preterm infants using individual participant data (IPD) meta-analysis.
- To compare and rank all available cord management strategies for preterm births using network meta-analysis (NMA).
Main Methods:
- Systematic literature searches identified randomized controlled trials comparing cord management strategies for preterm birth.
- Pairwise IPD meta-analyses and an IPD NMA were conducted to compare interventions and explore effects across participant subgroups.
- Primary outcome was death prior to hospital discharge; key secondary outcomes were also analyzed.
Main Results:
- Analysis of individual participant data (IPD) allows for detailed subgroup exploration of cord management strategies.
- Network meta-analysis (NMA) provides a ranking of interventions for preterm birth outcomes.
- Study will identify treatment effect differences by participant characteristics.
Conclusions:
- Findings will inform clinical practice and guideline development for preterm infant care.
- Dissemination through publications, presentations, and media releases will reach clinicians, policymakers, and the public.
- This research synthesizes evidence to optimize cord management in preterm neonates.
