دورية أكاديمية
أعرض في EDS

Deferred cord clamping, cord milking, and immediate cord clamping at preterm birth: a systematic review and individual participant data meta-analysis.

التفاصيل البيبلوغرافية
العنوان: Deferred cord clamping, cord milking, and immediate cord clamping at preterm birth: a systematic review and individual participant data meta-analysis.
المؤلفون: Seidler AL; University of Sydney, NHMRC Clinical Trials Centre, Sydney, NSW, Australia. Electronic address: lene.seidler@sydney.edu.au., Aberoumand M; University of Sydney, NHMRC Clinical Trials Centre, Sydney, NSW, Australia., Hunter KE; University of Sydney, NHMRC Clinical Trials Centre, Sydney, NSW, Australia., Barba A; University of Sydney, NHMRC Clinical Trials Centre, Sydney, NSW, Australia., Libesman S; University of Sydney, NHMRC Clinical Trials Centre, Sydney, NSW, Australia., Williams JG; University of Sydney, NHMRC Clinical Trials Centre, Sydney, NSW, Australia., Shrestha N; University of Sydney, NHMRC Clinical Trials Centre, Sydney, NSW, Australia., Aagerup J; University of Sydney, NHMRC Clinical Trials Centre, Sydney, NSW, Australia., Sotiropoulos JX; University of Sydney, NHMRC Clinical Trials Centre, Sydney, NSW, Australia., Montgomery AA; Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK., Gyte GML; National Childbirth Trust, London, UK., Duley L; Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK., Askie LM; University of Sydney, NHMRC Clinical Trials Centre, Sydney, NSW, Australia.
مؤلفون مشاركون: iCOMP Collaborators
المصدر: Lancet (London, England) [Lancet] 2023 Dec 09; Vol. 402 (10418), pp. 2209-2222. Date of Electronic Publication: 2023 Nov 14.
نوع المنشور: Systematic Review; Meta-Analysis; Journal Article; Research Support, Non-U.S. Gov't
اللغة: English
بيانات الدورية: Publisher: Elsevier Country of Publication: England NLM ID: 2985213R Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1474-547X (Electronic) Linking ISSN: 01406736 NLM ISO Abbreviation: Lancet Subsets: MEDLINE
أسماء مطبوعة: Publication: 2004- : London : Elsevier
Original Publication: London : J. Onwhyn
مواضيع طبية MeSH: Premature Birth*, Infant ; Pregnancy ; Infant, Newborn ; Humans ; Male ; Female ; Infant, Premature ; Umbilical Cord Clamping ; Constriction ; Australia ; Umbilical Cord/surgery
مستخلص: Background: Umbilical cord clamping strategies at preterm birth have the potential to affect important health outcomes. The aim of this study was to compare the effectiveness of deferred cord clamping, umbilical cord milking, and immediate cord clamping in reducing neonatal mortality and morbidity at preterm birth.
Methods: We conducted a systematic review and individual participant data meta-analysis. We searched medical databases and trial registries (from database inception until Feb 24, 2022; updated June 6, 2023) for randomised controlled trials comparing deferred (also known as delayed) cord clamping, cord milking, and immediate cord clamping for preterm births (<37 weeks' gestation). Quasi-randomised or cluster-randomised trials were excluded. Authors of eligible studies were invited to join the iCOMP collaboration and share individual participant data. All data were checked, harmonised, re-coded, and assessed for risk of bias following prespecified criteria. The primary outcome was death before hospital discharge. We performed intention-to-treat one-stage individual participant data meta-analyses accounting for heterogeneity to examine treatment effects overall and in prespecified subgroup analyses. Certainty of evidence was assessed with Grading of Recommendations Assessment, Development, and Evaluation. This study is registered with PROSPERO, CRD42019136640.
Findings: We identified 2369 records, of which 48 randomised trials provided individual participant data and were eligible for our primary analysis. We included individual participant data on 6367 infants (3303 [55%] male, 2667 [45%] female, two intersex, and 395 missing data). Deferred cord clamping, compared with immediate cord clamping, reduced death before discharge (odds ratio [OR] 0·68 [95% CI 0·51-0·91], high-certainty evidence, 20 studies, n=3260, 232 deaths). For umbilical cord milking compared with immediate cord clamping, no clear evidence was found of a difference in death before discharge (OR 0·73 [0·44-1·20], low certainty, 18 studies, n=1561, 74 deaths). Similarly, for umbilical cord milking compared with deferred cord clamping, no clear evidence was found of a difference in death before discharge (0·95 [0·59-1·53], low certainty, 12 studies, n=1303, 93 deaths). We found no evidence of subgroup differences for the primary outcome, including by gestational age, type of delivery, multiple birth, study year, and perinatal mortality.
Interpretation: This study provides high-certainty evidence that deferred cord clamping, compared with immediate cord clamping, reduces death before discharge in preterm infants. This effect appears to be consistent across several participant-level and trial-level subgroups. These results will inform international treatment recommendations.
Funding: Australian National Health and Medical Research Council.
Competing Interests: Declaration of interests iCOMP trial representatives comprised principal investigators of studies included in this meta-analysis. Trial representatives did not have input on study eligibility, data integrity assessments, data extraction, or risk of bias assessments for their own studies. Trial representatives did not make final decisions on certainty of evidence ratings. ALS is a recipient of Australian National Health and Medical Research Council (NHMRC) project and investigator grants (funds paid directly to the University of Sydney). JXS reports travel grants and scholarships from the Association of Interdisciplinary Meta-science and Open-Science, Pediatric Academic Societies, and the Perinatal Society of Australia and New Zealand. KEH is a recipient of NHMRC funding paid directly to the University of Sydney. The full list of iCOMP Collaborators and their declaration of interests are noted in the appendix (pp 371–374). All other authors have no competing interests.
(Copyright © 2023 Elsevier Ltd. All rights reserved.)
التعليقات: Comment in: Lancet. 2023 Dec 9;402(10418):2170-2171. (PMID: 37979597)
فهرسة مساهمة: Investigator: AL Seidler; M Aberoumand; KE Hunter; A Barba; S Libesman; JG Williams; N Shrestha; J Aagerup; JX Sotiropoulos; AA Montgomery; GML Gyte; A Garg; A Kumar; AC Tan; A Kugelman; AC Webster; AA George; A Thukral; AC Katheria; AB Te Pas; A Kc; B Urlesberger; B Schwaberger; CH Backes; C De Paco Matallana; C Tanprasertkul; C Ruangkit; D Chawla; DA Blank; E Okulu; EM Dempsey; G Ram Mohan; GR Polglase; G Carroli; HK Al-Wassia; H Rabe; HG Liley; H Atia; I Nour; JQ Liu; J Kattwinkel; JS Dorling; JS Mercer; JB Josephsen; KD Fairchild; K Wallace; KE Murphy; KP Robledo; MM Gharehbaghi; M de Veciana; M Goya; M Kluckow; MI March; MP Meyer; MK Mangla; NE Allam; N Nasef; NK Dipak; O Andersson; PG Davis; P Pongmee; RD Riley; RJ Simes; R Knol; S Arsan; S Shekhar; SS Belk; S Hosono; S Badurdeen; S Pratesi; S Dias; SB Hooper; T Sahoo; TPA Debray; VC Manoj; V Sundaram; V Lago; V Datta; W El-Naggar; WA Carlo; WO Tarnow-Mordi; L Duley; LM Askie
تواريخ الأحداث: Date Created: 20231117 Date Completed: 20231216 Latest Revision: 20240507
رمز التحديث: 20240507
DOI: 10.1016/S0140-6736(23)02468-6
PMID: 37977169
قاعدة البيانات: MEDLINE
الوصف
تدمد:1474-547X
DOI:10.1016/S0140-6736(23)02468-6