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Umbilical Cord Management for Newborns <34 Weeks' Gestation: A Meta-analysis.

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Delayed cord clamping (DCC) and intact-cord milking (ICM) may offer slight survival benefits for preterm infants. However, the optimal umbilical cord management strategy for these vulnerable infants remains uncertain, with early clamping potentially causing harm.

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Area of Science:

  • Neonatal Medicine
  • Perinatal Care
  • Evidence-Based Medicine

Background:

  • The International Liaison Committee on Resuscitation highlighted the need to review umbilical cord management strategies for preterm infants.
  • Current practices for umbilical cord management in preterm neonates (<34 weeks gestation) require rigorous scientific evaluation.

Purpose of the Study:

  • To evaluate the effects of different umbilical cord management strategies, specifically timing of cord clamping and cord milking, in preterm infants.
  • To synthesize evidence from randomized controlled trials on cord management interventions in neonates <34 weeks gestation.

Main Methods:

  • A systematic search of multiple databases (Cochrane, Medline, PubMed, Embase, CINAHL) and trial registries was conducted up to July 2019.
  • Forty-two randomized controlled trials involving 5772 preterm infants were included, with data independently extracted and assessed for risk of bias and evidence certainty (GRADE).

Main Results:

  • Delayed cord clamping (DCC) and intact-cord milking (ICM) showed a potential slight improvement in survival compared to early clamping, though with moderate certainty evidence.
  • Both DCC and ICM likely improve hematologic measures in preterm infants, but evidence does not strongly support an effect on major neonatal morbidities.
  • Certainty of evidence for many outcomes was low, and subgroup analyses were limited by data availability.

Conclusions:

  • Delayed cord clamping (DCC) demonstrates potential benefits for infants born before 34 weeks gestation.
  • Further research is needed to establish the benefits and harms of cord milking in preterm neonates.
  • The optimal umbilical cord management strategy for preterm infants is not yet definitively known, and early clamping may be detrimental.