• 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, GyteGillian M LGMLNational Childbirth Trust, London, UK., Lelia Duley, Lisa M Askie, and iCOMP Collaborators.
• University of Sydney, NHMRC Clinical Trials Centre, Sydney, Camperdown, NSW, Australia. Electronic address: lene.seidler@sydney.edu.au.
• Lancet. 2023 Dec 9; 402 (10418): 222322342223-2234.

BackgroundDeferred (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.MethodsWe 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 random-effects individual participant data network meta-analysis. This study was registered with PROSPERO, CRD42019136640.FindingsWe 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.InterpretationThis 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.FundingAustralian National Health and Medical Research Council.Copyright © 2023 Elsevier Ltd. All rights reserved.

26 keywords...

hide…