Cochrane · systematic review · CD003248
Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes
Rabe, H, Gyte, GML, Díaz‐Rossello, JL, et al. · Cochrane Database of Systematic Reviews · 2019 · Cochrane Library
Pregnancy and ChildbirthAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
28
current version
GRADE rated
25
No studies
0
Included studies
NR
No studies 0 · 0%Ungraded 3 · 10.7%Very low 3 · 10.7%Low 18 · 64.3%Moderate 2 · 7.1%High 2 · 7.1%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
DCC with immediate neonatal care after cord clamping compared to ECC (subgroup analysis by gestation) for health problem or population
Population: babies born preterm, and their mothers
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Death of baby (up to discharge) DCC with immediate neonatal care after cord clamping vs ECC (subgroup analysis by gestation) | RR 0.73 [0.54, 0.98] | 20 studies · 2680 participants | Moderate Downgraded: risk of bias |
Death or neurodevelopmental impairment in early years DCC with immediate neonatal care after cord clamping vs ECC (subgroup analysis by gestation) | no estimate extracted | 0 studies · 0 participants | Ungraded |
Severe intraventricular haemorrhage (IVH grades 3, 4) DCC with immediate neonatal care after cord clamping vs ECC (subgroup analysis by gestation) | RR 0.94 [0.63, 1.39] | 10 studies · 2058 participants | Low Downgraded: risk of bias |
Intraventricular haemorrhage (IVH, all grades) DCC with immediate neonatal care after cord clamping vs ECC (subgroup analysis by gestation) | RR 0.83 [0.7, 0.99] | 15 studies · 2333 participants | High |
Periventricular leukomalacia (PVL) DCC with immediate neonatal care after cord clamping vs ECC (subgroup analysis by gestation) | RR 0.58 [0.26, 1.3] | 4 studies · 1544 participants | Low Downgraded: risk of bias |
Chronic lung disease (CLD) ‐ oxygen supplement at 36 weeks (corrected for gestation) DCC with immediate neonatal care after cord clamping vs ECC (subgroup analysis by gestation) | RR 1.04 [0.94, 1.14] | 6 studies · 1644 participants | High |
Maternal blood loss of 500 mL or greater DCC with immediate neonatal care after cord clamping vs ECC (subgroup analysis by gestation) | RR 1.14 [0.07, 17.63] | 2 studies · 180 participants | Very low Downgraded: risk of bias |
DCC with immediate neonatal care with cord intact compared to ECC in babies born preterm
Population: babies born preterm, and their mothers
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Death of baby (up to discharge) DCC with immediate neonatal care with cord intact vs ECC | RR 0.47 [0.2, 1.11] | 1 study · 270 participants | Low Downgraded: imprecision |
Death or neurodevelopmental impairment at age 2 to 3 years DCC with immediate neonatal care with cord intact vs ECC | RR 0.61 [0.39, 0.96] | 1 study · 218 participants | Low Downgraded: risk of bias, imprecision |
Severe intraventricular haemorrhage (IVH grades 3, 4) DCC with immediate neonatal care with cord intact vs ECC | RR 0.84 [0.29, 2.45] | 1 study · 266 participants | Low Downgraded: risk of bias, imprecision |
Intraventricular haemorrhage (IVH, all grades) DCC with immediate neonatal care with cord intact vs ECC | RR 0.9 [0.64, 1.26] | 1 study · 266 participants | Low Downgraded: risk of bias, imprecision |
Periventricular leukomalacia (PVL) DCC with immediate neonatal care with cord intact vs ECC | RR 0.86 [0.32, 2.31] | 1 study · 266 participants | Low Downgraded: risk of bias, imprecision |
Chronic lung disease (CLD) ‐ oxygen supplement at 36 weeks (corrected for gestation) DCC with immediate neonatal care with cord intact vs ECC | RR 0.95 [0.66, 1.37] | 1 study · 249 participants | Low Downgraded: risk of bias, imprecision |
Maternal blood loss of 500 mL or greater DCC with immediate neonatal care with cord intact vs ECC | RR 0.94 [0.72, 1.22] | 1 study · 254 participants | Low Downgraded: risk of bias, imprecision |
DCC with immediate neonatal care after cord clamping compared to UCM in babes born preterm
Population: babies born preterm, and their mothers
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Death of baby (up to discharge) DCC with immediate neonatal care after cord clamping vs UCM | RR 2.14 [0.93, 4.93] | 3 studies · 322 participants | Low Downgraded: risk of bias |
Death or neurodevelopmental impairment at age 2 to 3 years DCC with immediate neonatal care after cord clamping vs UCM | RR 1.67 [0.78, 3.57] | 2 studies · 195 participants | Very low Downgraded: risk of bias, imprecision |
Severe intraventricular haemorrhage (IVH grades 3, 4) DCC with immediate neonatal care after cord clamping vs UCM | RR 2.63 [0.11, 61.88] | 1 study · 58 participants | Low Downgraded: risk of bias, imprecision |
Intraventricular haemorrhage (IVH, all grades) DCC with immediate neonatal care after cord clamping vs UCM | RR 1.32 [0.55, 3.17] | 2 studies · 125 participants | Very low Downgraded: risk of bias, imprecision |
Periventricular leukomalacia (PVL) DCC with immediate neonatal care after cord clamping vs UCM | no estimate extracted | 1 study · 58 participants | Low Downgraded: risk of bias, imprecision |
Chronic lung disease (CLD) ‐ oxygen supplement at 36 weeks (corrected for gestation) DCC with immediate neonatal care after cord clamping vs UCM | RR 1.53 [0.43, 5.48] | 2 studies · 125 participants | Low Downgraded: risk of bias, imprecision |
Maternal blood loss of 500 mL or greater DCC with immediate neonatal care after cord clamping vs UCM | no estimate extracted | 0 studies · 0 participants | Ungraded |
UCM compared to ECC in babies born preterm
Population: babies born preterm, and their mothers.
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Death of baby (up to discharge) UCM vs ECC | RR 0.81 [0.47, 1.41] | 9 studies · 931 participants | Low Downgraded: risk of bias |
Death or neurodevelopmental impairment at age 2 to 3 years UCM vs ECC | no estimate extracted | 0 studies · 0 participants | Ungraded |
Severe intraventricular haemorrhage (IVH grades 3, 4) UCM vs ECC | RR 0.75 [0.39, 1.45] | 6 studies · 618 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Intraventricular haemorrhage (IVH, all grades) UCM vs ECC | RR 0.85 [0.62, 1.18] | 8 studies · 716 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
Periventricular leukomalacia (PVL) UCM vs ECC | RR 0.63 [0.15, 2.63] | 3 studies · 315 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Chronic lung disease (CLD) ‐ oxygen supplement at 36 weeks (corrected for gestation) UCM vs ECC | RR 1.03 [0.64, 1.66] | 7 studies · 682 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Maternal blood loss of 500 mL or greater UCM vs ECC | no estimate extracted | 1 study · 200 participants | Low Downgraded: risk of bias, imprecision, inconsistency |