doi: 10.1002/14651858.CD003248.pub4.
Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes
Affiliations
- PMID: 31529790
- PMCID: PMC6748404
- DOI: 10.1002/14651858.CD003248.pub4
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Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes
Cochrane Database Syst Rev.
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Abstract
Background: Infants born preterm (before 37 weeks' gestation) have poorer outcomes than infants at term, particularly if born before 32 weeks. Early cord clamping has been standard practice over many years, and enables quick transfer of the infant to neonatal care. Delayed clamping allows blood flow between the placenta, umbilical cord and baby to continue, and may aid transition. Keeping baby at the mother's side enables neonatal care with the cord intact and this, along with delayed clamping, may improve outcomes. Umbilical cord milking (UCM) is proposed for increasing placental transfusion when immediate care for the preterm baby is needed. This Cochrane Review is a further update of a review first published in 2004 and updated in 2012.
Objectives: To assess the effects on infants born at less than 37 weeks' gestation, and their mothers of: 1) delayed cord clamping (DCC) compared with early cord clamping (ECC) both with immediate neonatal care after cord clamping; 2) DCC with immediate neonatal care with cord intact compared with ECC with immediate neonatal care after cord clamping; 3) DCC with immediate neonatal care after cord clamping compared with UCM; 4) UCM compared with ECC with immediate neonatal care after cord clamping.
Search methods: We searched the Cochrane Pregnancy and Childbirth Group Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (10 November 2017), and reference lists of retrieved studies. We updated the search in November 2018 and added nine new trial reports to the awaiting classification section to be assessed at the next update.
Selection criteria: Randomised controlled trials (RCTs) comparing delayed with early clamping of the umbilical cord (with immediate neonatal care after cord clamping or with cord intact) and UCM for births before 37 weeks' gestation. Quasi-RCTs were excluded.
Data collection and analysis: Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. Random-effects are used in all meta-analyses. Review authors assessed the certainty of the evidence using the GRADE approach.
Main results: This update includes forty-eight studies, involving 5721 babies and their mothers, with data available from 40 studies involving 4884 babies and their mothers. Babies were between 24 and 36+6 weeks' gestation at birth and multiple births were included. The data are mostly from high-income countries. Delayed clamping ranged between 30 to 180 seconds, with most studies delaying for 30 to 60 seconds. Early clamping was less than 30 seconds and often immediate. UCM was mostly before cord clamping but some were milked after cord clamping. We undertook subgroup analysis by gestation and type of intervention, and sensitivity analyses by low risk of selection and attrition bias.All studies were high risk for performance bias and many were unclear for other aspects of risk of bias. Certainty of the evidence using GRADE was mostly low, mainly due to imprecision and unclear risk of bias.Delayed cord clamping (DCC) versus early cord clamping (ECC) both with immediate neonatal care after cord clamping (25 studies, 3100 babies and their mothers)DCC probably reduces the number of babies who die before discharge compared with ECC (average risk ratio (aRR) 0.73, 95% confidence interval (CI) 0.54 to 0.98, 20 studies, 2680 babies (moderate certainty)).No studies reported on 'Death or neurodevelopmental impairment' in the early years'.DCC may make little or no difference to the number of babies with severe intraventricular haemorrhage (IVH grades 3 and 4) (aRR 0.94, 95% CI 0.63 to 1.39, 10 studies, 2058 babies, low certainty) but slightly reduces the number of babies with any grade IVH (aRR 0.83, 95% CI 0.70 to 0.99, 15 studies, 2333 babies, high certainty).DCC has little or no effect on chronic lung disease (CLD) (aRR 1.04, 95% CI 0.94 to 1.14, 6 studies, 1644 babies, high certainty).Due to insufficient data, we were unable to form conclusions regarding periventricular leukomalacia (PVL) (aRR 0.58, 95% CI 0.26 to 1.30, 4 studies, 1544 babies, low certainty) or maternal blood loss of 500 mL or greater (aRR 1.14, 95% CI 0.07 to 17.63, 2 studies, 180 women, very low certainty).We identified no important heterogeneity in subgroup or sensitivity analyses.Delayed cord clamping (DCC) with immediate neonatal care with cord intact versus early cord clamping (ECC) (one study, 276 babies and their mothers)There are insufficient data to be confident in our findings, but DCC with immediate neonatal care with cord intact may reduce the number of babies who die before discharge, although the data are also compatible with a slight increase in mortality, compared with ECC (aRR 0.47, 95% CI 0.20 to 1.11, 1 study, 270 babies, low certainty). DCC may also reduce the number of babies who die or have neurodevelopmental impairment in early years (aRR 0.61, 95% CI 0.39 to 0.96, 1 study, 218 babies, low certainty). There may be little or no difference in: severe IVH; all grades IVH; PVL; CLD; maternal blood loss ≥ 500 mL, assessed as low certainty mainly due to serious imprecision.Delayed cord clamping (DCC) with immediate neonatal care after cord clamping versus umbilical cord milking (UCM) (three studies, 322 babies and their mothers) and UCM versus early cord clamping (ECC) (11 studies, 1183 babies and their mothers)There are insufficient data for reliable conclusions about the comparative effects of UCM compared with delayed or early clamping (mostly low or very low certainty).
Authors' conclusions: Delayed, rather than early, cord clamping may reduce the risk of death before discharge for babies born preterm. There is insufficient evidence to show what duration of delay is best, one or several minutes, and therefore the optimum time to clamp the umbilical cord remains unclear. Whilst the current evidence supports not clamping the cord before 30 seconds at preterm births, future trials could compare different lengths of delay. Immediate neonatal care with the cord intact requires further study, and there are insufficient data on UCM.The nine new reports awaiting further classification may alter the conclusions of the review once assessed.
Conflict of interest statement
Heike Rabe is main author for two included studies in this review (Rabe 2000; Rabe 2011). Studies by the contact author, which may be relevant for inclusion in this review, were not assessed by herself but by the co‐authors who, in agreement with the Cochrane Pregnancy and Childbirth group, have named other experts in the field for this purpose.
Jose Diaz‐Rossello ‐ none known.
Lelia Duley has been awarded an NIHR research grant for a programme of work which includes a pilot trial of timing of cord clamping for preterm births (CORD Pilot 2018), and a prospective meta‐analysis.
Gillian Gyte was a co‐applicant on one of the included studies in this review (CORD Pilot 2018). She also has received royalties from John Wiley & Son in respect of ‘A Cochrane Pocket Handbook – Pregnancy and Childbirth' Hofmeyr GJ et al. 2008.
Figures
Study flow diagram.
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
Funnel plot of comparison: 1 DCC with immediate neonatal care after cord clamping vs ECC (subgroup analysis by gestation), outcome: 1.1 Death of baby (up to discharge).
Funnel plot of comparison: 1 DCC with immediate neonatal care after cord clamping vs ECC (subgroup analysis by gestation), outcome: 1.3 Severe intraventricular haemorrhage (IVH grades 3, 4).
Funnel plot of comparison: 1 DCC with immediate neonatal care after cord clamping vs ECC (subgroup analysis by gestation), outcome: 1.4 Intraventricular haemorrhage (IVH, all grades).
Comparison 1 DCC with immediate neonatal care after cord clamping vs ECC (subgroup analysis by gestation), Outcome 1 Death of baby (up to discharge).
Comparison 1 DCC with immediate neonatal care after cord clamping vs ECC (subgroup analysis by gestation), Outcome 3 Severe intraventricular haemorrhage (IVH grades 3, 4).
Comparison 1 DCC with immediate neonatal care after cord clamping vs ECC (subgroup analysis by gestation), Outcome 4 Intraventricular haemorrhage (IVH, all grades).
Comparison 1 DCC with immediate neonatal care after cord clamping vs ECC (subgroup analysis by gestation), Outcome 5 Periventricular leukomalacia (PVL).
Comparison 1 DCC with immediate neonatal care after cord clamping vs ECC (subgroup analysis by gestation), Outcome 6 Chronic lung disease (CLD) ‐ oxygen supplement at 36 weeks (corrected for gestation).
Comparison 1 DCC with immediate neonatal care after cord clamping vs ECC (subgroup analysis by gestation), Outcome 7 Maternal blood loss of 500 mL or greater.
Comparison 1 DCC with immediate neonatal care after cord clamping vs ECC (subgroup analysis by gestation), Outcome 8 Intraventricular haemorrhage (IVH, grades 1 & 2).
Comparison 1 DCC with immediate neonatal care after cord clamping vs ECC (subgroup analysis by gestation), Outcome 9 Necrotising enterocolitis (NEC) confirmed by X‐ray or laparotomy).
Comparison 1 DCC with immediate neonatal care after cord clamping vs ECC (subgroup analysis by gestation), Outcome 10 Respiratory Distress Syndrome (RDS).
Comparison 1 DCC with immediate neonatal care after cord clamping vs ECC (subgroup analysis by gestation), Outcome 11 Respiratory support (ventilator or CPAP).
Comparison 1 DCC with immediate neonatal care after cord clamping vs ECC (subgroup analysis by gestation), Outcome 12 Duration of respiratory support (in days).
Comparison 1 DCC with immediate neonatal care after cord clamping vs ECC (subgroup analysis by gestation), Outcome 13 Surfactant treatment (for severe RDS).
Comparison 1 DCC with immediate neonatal care after cord clamping vs ECC (subgroup analysis by gestation), Outcome 14 Treatment for Patent Ductus Arteriosus (PDA) (medical and/or surgical).
Comparison 1 DCC with immediate neonatal care after cord clamping vs ECC (subgroup analysis by gestation), Outcome 15 Treatment for Retinopathy of Prematurity (RoP).
Comparison 1 DCC with immediate neonatal care after cord clamping vs ECC (subgroup analysis by gestation), Outcome 16 Hyperbilirubinemia (treated by phototherapy).
Comparison 1 DCC with immediate neonatal care after cord clamping vs ECC (subgroup analysis by gestation), Outcome 17 Inotropics for low blood pressure.
Comparison 1 DCC with immediate neonatal care after cord clamping vs ECC (subgroup analysis by gestation), Outcome 18 Low Apgar as defined by trialists (generally < 8 at 5 mins).
Comparison 1 DCC with immediate neonatal care after cord clamping vs ECC (subgroup analysis by gestation), Outcome 19 Blood transfusion in infant.
Comparison 1 DCC with immediate neonatal care after cord clamping vs ECC (subgroup analysis by gestation), Outcome 20 Volume of blood transfused (mL).
Comparison 1 DCC with immediate neonatal care after cord clamping vs ECC (subgroup analysis by gestation), Outcome 21 Late sepsis (after 3 days or as defined by trialists).
Comparison 1 DCC with immediate neonatal care after cord clamping vs ECC (subgroup analysis by gestation), Outcome 23 Temperature < 36.0oC within 1 hour of birth.
Comparison 1 DCC with immediate neonatal care after cord clamping vs ECC (subgroup analysis by gestation), Outcome 24 Hb within 1st 24 hour of birth (g/dL).
Comparison 1 DCC with immediate neonatal care after cord clamping vs ECC (subgroup analysis by gestation), Outcome 25 Mean arterial blood pressure in early hours after birth (mm Hg).
Comparison 1 DCC with immediate neonatal care after cord clamping vs ECC (subgroup analysis by gestation), Outcome 27 Home oxygen.
Comparison 1 DCC with immediate neonatal care after cord clamping vs ECC (subgroup analysis by gestation), Outcome 33 Blood transfusion for mother.
Comparison 1 DCC with immediate neonatal care after cord clamping vs ECC (subgroup analysis by gestation), Outcome 39 Fully breastfed or mixed feeding at infant discharge.
Comparison 2 DCC with immediate neonatal care after cord clamping vs ECC (subgroup analysis by type of intervention), Outcome 1 Death of baby (up to discharge).
Comparison 2 DCC with immediate neonatal care after cord clamping vs ECC (subgroup analysis by type of intervention), Outcome 3 Severe intraventricular haemorrhage (IVH grades 3, 4).
Comparison 2 DCC with immediate neonatal care after cord clamping vs ECC (subgroup analysis by type of intervention), Outcome 4 Intraventricular haemorrhage (IVH, all grades).
Comparison 2 DCC with immediate neonatal care after cord clamping vs ECC (subgroup analysis by type of intervention), Outcome 5 Periventricular leukomalacia (PVL).
Comparison 2 DCC with immediate neonatal care after cord clamping vs ECC (subgroup analysis by type of intervention), Outcome 6 Chronic lung disease (CLD) ‐ oxygen supplement at 36 weeks (corrected for gestation).
Comparison 2 DCC with immediate neonatal care after cord clamping vs ECC (subgroup analysis by type of intervention), Outcome 7 Maternal blood loss of 500 mL or greater.
Comparison 2 DCC with immediate neonatal care after cord clamping vs ECC (subgroup analysis by type of intervention), Outcome 8 Intraventricular haemorrhage (IVH, grades 1 & 2).
Comparison 2 DCC with immediate neonatal care after cord clamping vs ECC (subgroup analysis by type of intervention), Outcome 9 Necrotising enterocolitis (NEC) confirmed by X‐ray or laparotomy).
Comparison 2 DCC with immediate neonatal care after cord clamping vs ECC (subgroup analysis by type of intervention), Outcome 10 Respiratory Distress Syndrome (RDS).
Comparison 2 DCC with immediate neonatal care after cord clamping vs ECC (subgroup analysis by type of intervention), Outcome 11 Respiratory support (ventilator or CPAP).
Comparison 2 DCC with immediate neonatal care after cord clamping vs ECC (subgroup analysis by type of intervention), Outcome 12 Duration of respiratory support.
Comparison 2 DCC with immediate neonatal care after cord clamping vs ECC (subgroup analysis by type of intervention), Outcome 13 Surfactant treatment (for severe RDS).
Comparison 2 DCC with immediate neonatal care after cord clamping vs ECC (subgroup analysis by type of intervention), Outcome 14 Treatment for Patent Ductus Arteriosus (PDA) (medical and/or surgical).
Comparison 2 DCC with immediate neonatal care after cord clamping vs ECC (subgroup analysis by type of intervention), Outcome 15 Treatment for Retinopathy of Prematurity (RoP).
Comparison 2 DCC with immediate neonatal care after cord clamping vs ECC (subgroup analysis by type of intervention), Outcome 16 Hyperbilirubinemia (treated by phototherapy).
Comparison 2 DCC with immediate neonatal care after cord clamping vs ECC (subgroup analysis by type of intervention), Outcome 17 Inotropics for low blood pressure.
Comparison 2 DCC with immediate neonatal care after cord clamping vs ECC (subgroup analysis by type of intervention), Outcome 18 Low Apgar as defined by trialists (generally < 8 at 5 mins).
Comparison 2 DCC with immediate neonatal care after cord clamping vs ECC (subgroup analysis by type of intervention), Outcome 19 Blood transfusion in infant.
Comparison 2 DCC with immediate neonatal care after cord clamping vs ECC (subgroup analysis by type of intervention), Outcome 20 Volume of blood transfused (mL).
Comparison 2 DCC with immediate neonatal care after cord clamping vs ECC (subgroup analysis by type of intervention), Outcome 21 Late sepsis (after 3 days or as defined by trialists).
Comparison 2 DCC with immediate neonatal care after cord clamping vs ECC (subgroup analysis by type of intervention), Outcome 23 Temperature < 36.0oC within 1 hour of birth.
Comparison 2 DCC with immediate neonatal care after cord clamping vs ECC (subgroup analysis by type of intervention), Outcome 24 Hb within 1st 24 hour of birth (g/dL).
Comparison 2 DCC with immediate neonatal care after cord clamping vs ECC (subgroup analysis by type of intervention), Outcome 25 Mean arterial blood pressure in early hours after birth (mm Hg).
Comparison 2 DCC with immediate neonatal care after cord clamping vs ECC (subgroup analysis by type of intervention), Outcome 27 Home oxygen.
Comparison 2 DCC with immediate neonatal care after cord clamping vs ECC (subgroup analysis by type of intervention), Outcome 33 Blood transfusion for mother.
Comparison 2 DCC with immediate neonatal care after cord clamping vs ECC (subgroup analysis by type of intervention), Outcome 39 Fully breastfed or mixed feeding at infant discharge.
Comparison 2 DCC with immediate neonatal care after cord clamping vs ECC (subgroup analysis by type of intervention), Outcome 42 Neurosensory disability at 7 months (Bailey's MDI < 70) ‐ not prespecified.
Comparison 3 DCC with immediate neonatal care with cord intact vs ECC (subgroup analysis by gestation), Outcome 1 Death of baby (up to discharge).
Comparison 3 DCC with immediate neonatal care with cord intact vs ECC (subgroup analysis by gestation), Outcome 2 Death or neurodevelopmental impairment at age two to three years.
Comparison 3 DCC with immediate neonatal care with cord intact vs ECC (subgroup analysis by gestation), Outcome 3 Severe intraventricular haemorrhage (IVH grades 3, 4).
Comparison 3 DCC with immediate neonatal care with cord intact vs ECC (subgroup analysis by gestation), Outcome 4 Intraventricular haemorrhage (IVH, all grades).
Comparison 3 DCC with immediate neonatal care with cord intact vs ECC (subgroup analysis by gestation), Outcome 5 Periventricular leukomalacia (PVL).
Comparison 3 DCC with immediate neonatal care with cord intact vs ECC (subgroup analysis by gestation), Outcome 6 Chronic lung disease (CLD) ‐ oxygen supplement at 36 weeks (corrected for gestation).
Comparison 3 DCC with immediate neonatal care with cord intact vs ECC (subgroup analysis by gestation), Outcome 7 Maternal blood loss of 500 mL or greater.
Comparison 3 DCC with immediate neonatal care with cord intact vs ECC (subgroup analysis by gestation), Outcome 8 Intraventricular haemorrhage (IVH, grades 1 & 2).
Comparison 3 DCC with immediate neonatal care with cord intact vs ECC (subgroup analysis by gestation), Outcome 9 Necrotising enterocolitis (NEC) confirmed by X‐ray or laparotomy).
Comparison 3 DCC with immediate neonatal care with cord intact vs ECC (subgroup analysis by gestation), Outcome 11 Respiratory support (ventilator or CPAP).
Comparison 3 DCC with immediate neonatal care with cord intact vs ECC (subgroup analysis by gestation), Outcome 14 Treatment for Patent Ductus Arteriosus (PDA) (medical and/or surgical).
Comparison 3 DCC with immediate neonatal care with cord intact vs ECC (subgroup analysis by gestation), Outcome 15 Treatment for Retinopathy of Prematurity (RoP).
Comparison 3 DCC with immediate neonatal care with cord intact vs ECC (subgroup analysis by gestation), Outcome 16 Hyperbilirubinemia (treated by phototherapy).
Comparison 3 DCC with immediate neonatal care with cord intact vs ECC (subgroup analysis by gestation), Outcome 19 Blood transfusion in infant.
Comparison 3 DCC with immediate neonatal care with cord intact vs ECC (subgroup analysis by gestation), Outcome 21 Late sepsis (after 3 days or as defined by trialists).
Comparison 3 DCC with immediate neonatal care with cord intact vs ECC (subgroup analysis by gestation), Outcome 22 Hydrocephalus.
Comparison 3 DCC with immediate neonatal care with cord intact vs ECC (subgroup analysis by gestation), Outcome 23 Temperature < 36.0oC within 1 hour of birth.
Comparison 3 DCC with immediate neonatal care with cord intact vs ECC (subgroup analysis by gestation), Outcome 28 Neurodevelopmental impairment at age two to three years.
Comparison 3 DCC with immediate neonatal care with cord intact vs ECC (subgroup analysis by gestation), Outcome 31 Manual removal of placenta (denominator = vaginal births).
Comparison 3 DCC with immediate neonatal care with cord intact vs ECC (subgroup analysis by gestation), Outcome 32 Prolonged third stage (>30 minutes) (denominator = vaginal births).
Comparison 3 DCC with immediate neonatal care with cord intact vs ECC (subgroup analysis by gestation), Outcome 33 Blood transfusion for mother.
Comparison 3 DCC with immediate neonatal care with cord intact vs ECC (subgroup analysis by gestation), Outcome 34 Postpartum infection in mother.
Comparison 3 DCC with immediate neonatal care with cord intact vs ECC (subgroup analysis by gestation), Outcome 39 Fully breastfed or mixed feeding at infant discharge.
Comparison 4 DCC with immediate neonatal care with cord intact vs ECC (subgroup analysis by type of intervention), Outcome 1 Death of baby (up to discharge).
Comparison 4 DCC with immediate neonatal care with cord intact vs ECC (subgroup analysis by type of intervention), Outcome 2 Death or neurodevelopmental impairment at age two to three years.
Comparison 4 DCC with immediate neonatal care with cord intact vs ECC (subgroup analysis by type of intervention), Outcome 3 Severe intraventricular haemorrhage (IVH grades 3, 4).
Comparison 4 DCC with immediate neonatal care with cord intact vs ECC (subgroup analysis by type of intervention), Outcome 4 Intraventricular haemorrhage (IVH, all grades).
Comparison 4 DCC with immediate neonatal care with cord intact vs ECC (subgroup analysis by type of intervention), Outcome 5 Periventricular leukomalacia (PVL).
Comparison 4 DCC with immediate neonatal care with cord intact vs ECC (subgroup analysis by type of intervention), Outcome 6 Chronic lung disease (CLD) ‐ oxygen supplement at 36 weeks (corrected for gestation).
Comparison 4 DCC with immediate neonatal care with cord intact vs ECC (subgroup analysis by type of intervention), Outcome 7 Maternal blood loss of 500 mL or greater.
Comparison 4 DCC with immediate neonatal care with cord intact vs ECC (subgroup analysis by type of intervention), Outcome 8 Intraventricular haemorrhage (IVH, grades 1 & 2).
Comparison 4 DCC with immediate neonatal care with cord intact vs ECC (subgroup analysis by type of intervention), Outcome 9 Necrotising enterocolitis (NEC) confirmed by X‐ray or laparotomy).
Comparison 4 DCC with immediate neonatal care with cord intact vs ECC (subgroup analysis by type of intervention), Outcome 11 Respiratory support (ventilator or CPAP).
Comparison 4 DCC with immediate neonatal care with cord intact vs ECC (subgroup analysis by type of intervention), Outcome 14 Treatment for Patent Ductus Arteriosus (PDA) (medical and/or surgical).
Comparison 4 DCC with immediate neonatal care with cord intact vs ECC (subgroup analysis by type of intervention), Outcome 15 Treatment for Retinopathy of Prematurity (RoP).
Comparison 4 DCC with immediate neonatal care with cord intact vs ECC (subgroup analysis by type of intervention), Outcome 16 Hyperbilirubinemia (treated by phototherapy).
Comparison 4 DCC with immediate neonatal care with cord intact vs ECC (subgroup analysis by type of intervention), Outcome 19 Blood transfusion in infant.
Comparison 4 DCC with immediate neonatal care with cord intact vs ECC (subgroup analysis by type of intervention), Outcome 21 Late sepsis (after 3 days or as defined by trialists).
Comparison 4 DCC with immediate neonatal care with cord intact vs ECC (subgroup analysis by type of intervention), Outcome 22 Hydrocephalus.
Comparison 4 DCC with immediate neonatal care with cord intact vs ECC (subgroup analysis by type of intervention), Outcome 23 Temperature < 36.0oC within 1 hour of birth.
Comparison 4 DCC with immediate neonatal care with cord intact vs ECC (subgroup analysis by type of intervention), Outcome 28 Neurodevelopmental impairment at age two to three years.
Comparison 4 DCC with immediate neonatal care with cord intact vs ECC (subgroup analysis by type of intervention), Outcome 31 Manual removal of placenta (denominator = vaginal births).
Comparison 4 DCC with immediate neonatal care with cord intact vs ECC (subgroup analysis by type of intervention), Outcome 32 Prolonged third stage (>30 minutes) (denominator = vaginal births).
Comparison 4 DCC with immediate neonatal care with cord intact vs ECC (subgroup analysis by type of intervention), Outcome 33 Blood transfusion for mother.
Comparison 4 DCC with immediate neonatal care with cord intact vs ECC (subgroup analysis by type of intervention), Outcome 34 Postpartum infection in mother.
Comparison 4 DCC with immediate neonatal care with cord intact vs ECC (subgroup analysis by type of intervention), Outcome 39 Fully breastfed or mixed feeding at infant discharge.
Comparison 5 DCC with immediate neonatal care after cord clamping vs UCM (subgroup analysis by gestation), Outcome 1 Death of baby (up to discharge).
Comparison 5 DCC with immediate neonatal care after cord clamping vs UCM (subgroup analysis by gestation), Outcome 2 Death or neurodevelopmental impairment at age two to three years.
Comparison 5 DCC with immediate neonatal care after cord clamping vs UCM (subgroup analysis by gestation), Outcome 3 Severe intraventricular haemorrhage (IVH grades 3, 4).
Comparison 5 DCC with immediate neonatal care after cord clamping vs UCM (subgroup analysis by gestation), Outcome 4 Intraventricular haemorrhage (IVH, all grades).
Comparison 5 DCC with immediate neonatal care after cord clamping vs UCM (subgroup analysis by gestation), Outcome 5 Periventricular leukomalacia (PVL).
Comparison 5 DCC with immediate neonatal care after cord clamping vs UCM (subgroup analysis by gestation), Outcome 6 Chronic lung disease (CLD) ‐ oxygen supplement at 36 weeks (corrected for gestation).
Comparison 5 DCC with immediate neonatal care after cord clamping vs UCM (subgroup analysis by gestation), Outcome 8 Intraventricular haemorrhage (IVH, grades 1 & 2).
Comparison 5 DCC with immediate neonatal care after cord clamping vs UCM (subgroup analysis by gestation), Outcome 9 Necrotising enterocolitis (NEC) confirmed by X‐ray or laparotomy).
Comparison 5 DCC with immediate neonatal care after cord clamping vs UCM (subgroup analysis by gestation), Outcome 12 Duration of respiratory support (days).
Comparison 5 DCC with immediate neonatal care after cord clamping vs UCM (subgroup analysis by gestation), Outcome 13 Surfactant treatment (for severe RDS).
Comparison 5 DCC with immediate neonatal care after cord clamping vs UCM (subgroup analysis by gestation), Outcome 15 Treatment for Retinopathy of Prematurity (RoP).
Comparison 5 DCC with immediate neonatal care after cord clamping vs UCM (subgroup analysis by gestation), Outcome 19 Blood transfusion in infant.
Comparison 5 DCC with immediate neonatal care after cord clamping vs UCM (subgroup analysis by gestation), Outcome 21 Late sepsis (after 3 days or as defined by trialists).
Comparison 5 DCC with immediate neonatal care after cord clamping vs UCM (subgroup analysis by gestation), Outcome 22 Hydrocephalus.
Comparison 5 DCC with immediate neonatal care after cord clamping vs UCM (subgroup analysis by gestation), Outcome 24 Hb within 1st 24 hour of birth (g/dL).
Comparison 5 DCC with immediate neonatal care after cord clamping vs UCM (subgroup analysis by gestation), Outcome 27 Home oxygen.
Comparison 5 DCC with immediate neonatal care after cord clamping vs UCM (subgroup analysis by gestation), Outcome 28 Neurodevelopmental impairment at age two to three years.
Comparison 5 DCC with immediate neonatal care after cord clamping vs UCM (subgroup analysis by gestation), Outcome 29 Severe visual impairment.
Comparison 5 DCC with immediate neonatal care after cord clamping vs UCM (subgroup analysis by gestation), Outcome 30 Cerebral palsy (CP).
Comparison 6 DCC with immediate neonatal care after cord clamping vs UCM (subgroup analysis by type of intervention), Outcome 1 Death of baby (up to discharge).
Comparison 6 DCC with immediate neonatal care after cord clamping vs UCM (subgroup analysis by type of intervention), Outcome 2 Death or neurodevelopmental impairment at age two to three years.
Comparison 6 DCC with immediate neonatal care after cord clamping vs UCM (subgroup analysis by type of intervention), Outcome 3 Severe intraventricular haemorrhage (IVH grades 3, 4).
Comparison 6 DCC with immediate neonatal care after cord clamping vs UCM (subgroup analysis by type of intervention), Outcome 4 Intraventricular haemorrhage (IVH, all grades).
Comparison 6 DCC with immediate neonatal care after cord clamping vs UCM (subgroup analysis by type of intervention), Outcome 5 Periventricular leukomalacia (PVL).
Comparison 6 DCC with immediate neonatal care after cord clamping vs UCM (subgroup analysis by type of intervention), Outcome 6 Chronic lung disease (CLD) ‐ oxygen supplement at 36 weeks (corrected for gestation).
Comparison 6 DCC with immediate neonatal care after cord clamping vs UCM (subgroup analysis by type of intervention), Outcome 8 Intraventricular haemorrhage (IVH, grades 1 & 2).
Comparison 6 DCC with immediate neonatal care after cord clamping vs UCM (subgroup analysis by type of intervention), Outcome 12 Duration of respiratory support (days).
Comparison 6 DCC with immediate neonatal care after cord clamping vs UCM (subgroup analysis by type of intervention), Outcome 13 Surfactant treatment (for severe RDS).
Comparison 6 DCC with immediate neonatal care after cord clamping vs UCM (subgroup analysis by type of intervention), Outcome 15 Treatment for Retinopathy of Prematurity (RoP).
Comparison 6 DCC with immediate neonatal care after cord clamping vs UCM (subgroup analysis by type of intervention), Outcome 19 Blood transfusion in infant.
Comparison 6 DCC with immediate neonatal care after cord clamping vs UCM (subgroup analysis by type of intervention), Outcome 21 Late sepsis (after 3 days or as defined by trialists).
Comparison 6 DCC with immediate neonatal care after cord clamping vs UCM (subgroup analysis by type of intervention), Outcome 22 Hydrocephalus.
Comparison 6 DCC with immediate neonatal care after cord clamping vs UCM (subgroup analysis by type of intervention), Outcome 24 Hb within 1st 24 hour of birth (g/dL).
Comparison 6 DCC with immediate neonatal care after cord clamping vs UCM (subgroup analysis by type of intervention), Outcome 27 Home oxygen.
Comparison 6 DCC with immediate neonatal care after cord clamping vs UCM (subgroup analysis by type of intervention), Outcome 28 Neurodevelopmental impairment at age two to three years.
Comparison 6 DCC with immediate neonatal care after cord clamping vs UCM (subgroup analysis by type of intervention), Outcome 29 Severe visual impairment.
Comparison 6 DCC with immediate neonatal care after cord clamping vs UCM (subgroup analysis by type of intervention), Outcome 30 Cerebral palsy (CP).
Comparison 7 UCM vs ECC (subgroup analysis by gestation), Outcome 1 Death of baby (up to discharge).
Comparison 7 UCM vs ECC (subgroup analysis by gestation), Outcome 3 Severe intraventricular haemorrhage (IVH grades 3, 4).
Comparison 7 UCM vs ECC (subgroup analysis by gestation), Outcome 4 Intraventricular haemorrhage (IVH, all grades).
Comparison 7 UCM vs ECC (subgroup analysis by gestation), Outcome 5 Periventricular leukomalacia (PVL).
Comparison 7 UCM vs ECC (subgroup analysis by gestation), Outcome 6 Chronic lung disease (CLD) ‐ oxygen supplement at 36 weeks (corrected for gestation).
Comparison 7 UCM vs ECC (subgroup analysis by gestation), Outcome 7 Maternal blood loss of 500 mL or greater.
Comparison 7 UCM vs ECC (subgroup analysis by gestation), Outcome 8 Intraventricular haemorrhage (IVH, grades 1 & 2).
Comparison 7 UCM vs ECC (subgroup analysis by gestation), Outcome 9 Necrotising enterocolitis (NEC) confirmed by X‐ray or laparotomy).
Comparison 7 UCM vs ECC (subgroup analysis by gestation), Outcome 10 Respiratory Distress Syndrome (RDS).
Comparison 7 UCM vs ECC (subgroup analysis by gestation), Outcome 11 Respiratory support (ventilator or CPAP).
Comparison 7 UCM vs ECC (subgroup analysis by gestation), Outcome 12 Duration of respiratory support (days).
Comparison 7 UCM vs ECC (subgroup analysis by gestation), Outcome 13 Surfactant treatment (for severe RDS).
Comparison 7 UCM vs ECC (subgroup analysis by gestation), Outcome 14 Treatment for Patent Ductus Arteriosus (PDA) (medical and/or surgical).
Comparison 7 UCM vs ECC (subgroup analysis by gestation), Outcome 15 Treatment for Retinopathy of Prematurity (RoP).
Comparison 7 UCM vs ECC (subgroup analysis by gestation), Outcome 16 Hyperbilirubinemia (treated by phototherapy).
Comparison 7 UCM vs ECC (subgroup analysis by gestation), Outcome 17 Inotropics for low blood pressure.
Comparison 7 UCM vs ECC (subgroup analysis by gestation), Outcome 18 Low Apgar as defined by trialists (generally < 8 at 5 mins).
Comparison 7 UCM vs ECC (subgroup analysis by gestation), Outcome 19 Blood transfusion in infant.
Comparison 7 UCM vs ECC (subgroup analysis by gestation), Outcome 20 Volume of blood transfused (mL).
Comparison 7 UCM vs ECC (subgroup analysis by gestation), Outcome 21 Late sepsis (after 3 days or as defined by trialists).
Comparison 7 UCM vs ECC (subgroup analysis by gestation), Outcome 24 Hb within 1st 24 hour of birth (g/dL).
Comparison 7 UCM vs ECC (subgroup analysis by gestation), Outcome 25 Mean arterial blood pressure.
Comparison 7 UCM vs ECC (subgroup analysis by gestation), Outcome 26 Length of infant stay in NICU (in weeks).
Comparison 7 UCM vs ECC (subgroup analysis by gestation), Outcome 27 Home oxygen.
Comparison 7 UCM vs ECC (subgroup analysis by gestation), Outcome 28 Neurodevelopmental impairment at age two to three years.
Comparison 7 UCM vs ECC (subgroup analysis by gestation), Outcome 29 Severe visual impairment.
Comparison 7 UCM vs ECC (subgroup analysis by gestation), Outcome 30 Cerebral palsy (CP).
Comparison 8 UCM vs ECC (subgroup analysis by type of intervention), Outcome 1 Death of baby (up to discharge).
Comparison 8 UCM vs ECC (subgroup analysis by type of intervention), Outcome 3 Severe intraventricular haemorrhage (IVH grades 3, 4).
Comparison 8 UCM vs ECC (subgroup analysis by type of intervention), Outcome 4 Intraventricular haemorrhage (IVH, all grades).
Comparison 8 UCM vs ECC (subgroup analysis by type of intervention), Outcome 5 Periventricular leukomalacia (PVL).
Comparison 8 UCM vs ECC (subgroup analysis by type of intervention), Outcome 6 Chronic lung disease (CLD) ‐ oxygen supplement at 36 weeks (corrected for gestation).
Comparison 8 UCM vs ECC (subgroup analysis by type of intervention), Outcome 7 Maternal blood loss of 500 mL or greater.
Comparison 8 UCM vs ECC (subgroup analysis by type of intervention), Outcome 8 Intraventricular haemorrhage (IVH, grades 1 & 2).
Comparison 8 UCM vs ECC (subgroup analysis by type of intervention), Outcome 9 Necrotising enterocolitis (NEC) confirmed by X‐ray or laparotomy).
Comparison 8 UCM vs ECC (subgroup analysis by type of intervention), Outcome 10 Respiratory Distress Syndrome (RDS).
Comparison 8 UCM vs ECC (subgroup analysis by type of intervention), Outcome 11 Respiratory support (ventilator or CPAP).
Comparison 8 UCM vs ECC (subgroup analysis by type of intervention), Outcome 12 Duration of respiratory support (days).
Comparison 8 UCM vs ECC (subgroup analysis by type of intervention), Outcome 13 Surfactant treatment (for severe RDS).
Comparison 8 UCM vs ECC (subgroup analysis by type of intervention), Outcome 14 Treatment for Patent Ductus Arteriosus (PDA) (medical and/or surgical).
Comparison 8 UCM vs ECC (subgroup analysis by type of intervention), Outcome 15 Treatment for Retinopathy of Prematurity (RoP).
Comparison 8 UCM vs ECC (subgroup analysis by type of intervention), Outcome 16 Hyperbilirubinemia (treated by phototherapy).
Comparison 8 UCM vs ECC (subgroup analysis by type of intervention), Outcome 17 Inotropics for low blood pressure.
Comparison 8 UCM vs ECC (subgroup analysis by type of intervention), Outcome 18 Low Apgar as defined by trialists (generally < 8 at 5 mins).
Comparison 8 UCM vs ECC (subgroup analysis by type of intervention), Outcome 19 Blood transfusion in infant (mL).
Comparison 8 UCM vs ECC (subgroup analysis by type of intervention), Outcome 20 Volume of blood transfused.
Comparison 8 UCM vs ECC (subgroup analysis by type of intervention), Outcome 21 Late sepsis (after 3 days or as defined by trialists).
Comparison 8 UCM vs ECC (subgroup analysis by type of intervention), Outcome 24 Hb within 1st 24 hour of birth (g/dL).
Comparison 8 UCM vs ECC (subgroup analysis by type of intervention), Outcome 25 Mean arterial blood pressure (subgrouped by time after birth).
Comparison 8 UCM vs ECC (subgroup analysis by type of intervention), Outcome 26 Length of infant stay in NICU.
Comparison 8 UCM vs ECC (subgroup analysis by type of intervention), Outcome 27 Home oxygen.
Comparison 8 UCM vs ECC (subgroup analysis by type of intervention), Outcome 28 Neurodevelopmental impairment at age two to three years.
Comparison 8 UCM vs ECC (subgroup analysis by type of intervention), Outcome 29 Severe visual impairment.
Comparison 8 UCM vs ECC (subgroup analysis by type of intervention), Outcome 30 Cerebral palsy (CP).
Comparison 9 DCC with immediate neonatal care after cord clamping vs ECC (low risk of bias), Outcome 1 Death of baby (up to discharge).
Comparison 9 DCC with immediate neonatal care after cord clamping vs ECC (low risk of bias), Outcome 3 Severe intraventricular haemorrhage (IVH grades 3, 4).
Comparison 9 DCC with immediate neonatal care after cord clamping vs ECC (low risk of bias), Outcome 4 Intraventricular haemorrhage (IVH, all grades).
Comparison 9 DCC with immediate neonatal care after cord clamping vs ECC (low risk of bias), Outcome 5 Periventricular leukomalacia (PVL).
Comparison 9 DCC with immediate neonatal care after cord clamping vs ECC (low risk of bias), Outcome 6 Chronic lung disease (CLD) ‐ oxygen supplement at 36 weeks (corrected for gestation).
Comparison 9 DCC with immediate neonatal care after cord clamping vs ECC (low risk of bias), Outcome 7 Maternal blood loss of 500 mL or greater.
Comparison 10 DCC with immediate neonatal care with cord intact vs ECC (low risk of bias), Outcome 1 Death of baby (up to discharge).
Comparison 10 DCC with immediate neonatal care with cord intact vs ECC (low risk of bias), Outcome 2 Death or neurodevelopmental impairment in early years.
Comparison 10 DCC with immediate neonatal care with cord intact vs ECC (low risk of bias), Outcome 3 Severe intraventricular haemorrhage (IVH grades 3, 4).
Comparison 10 DCC with immediate neonatal care with cord intact vs ECC (low risk of bias), Outcome 4 Intraventricular haemorrhage (IVH, all grades).
Comparison 10 DCC with immediate neonatal care with cord intact vs ECC (low risk of bias), Outcome 5 Periventricular leukomalacia (PVL).
Comparison 10 DCC with immediate neonatal care with cord intact vs ECC (low risk of bias), Outcome 6 Chronic lung disease (CLD) ‐ oxygen supplement at 36 weeks (corrected for gestation).
Comparison 10 DCC with immediate neonatal care with cord intact vs ECC (low risk of bias), Outcome 7 Maternal blood loss of 500 mL or greater.
Comparison 11 DCC with immediate neonatal care after cord clamping vs UCM (low risk of bias), Outcome 1 Death of baby (up to discharge).
Comparison 11 DCC with immediate neonatal care after cord clamping vs UCM (low risk of bias), Outcome 2 Death or neurodevelopmental impairment in early years.
Comparison 11 DCC with immediate neonatal care after cord clamping vs UCM (low risk of bias), Outcome 3 Severe intraventricular haemorrhage (IVH grades 3, 4).
Comparison 11 DCC with immediate neonatal care after cord clamping vs UCM (low risk of bias), Outcome 4 Intraventricular haemorrhage (IVH, all grades).
Comparison 11 DCC with immediate neonatal care after cord clamping vs UCM (low risk of bias), Outcome 5 Periventricular leukomalacia (PVL).
Comparison 11 DCC with immediate neonatal care after cord clamping vs UCM (low risk of bias), Outcome 6 Chronic lung disease (CLD) ‐ oxygen supplement at 36 weeks (corrected for gestation).
Comparison 12 UCM vs ECC (low risk of bias), Outcome 1 Death of baby (up to discharge).
Comparison 12 UCM vs ECC (low risk of bias), Outcome 3 Severe intraventricular haemorrhage (IVH grades 3, 4).
Comparison 12 UCM vs ECC (low risk of bias), Outcome 4 Intraventricular haemorrhage (IVH, all grades).
Comparison 12 UCM vs ECC (low risk of bias), Outcome 5 Periventricular leukomalacia (PVL).
Comparison 12 UCM vs ECC (low risk of bias), Outcome 6 Chronic lung disease (CLD) ‐ oxygen supplement at 36 weeks (corrected for gestation).
Comparison 12 UCM vs ECC (low risk of bias), Outcome 7 Maternal blood loss of 500 mL or greater.
Update of
-
Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes.Cochrane Database Syst Rev. 2012 Aug 15;(8):CD003248. doi: 10.1002/14651858.CD003248.pub3. Cochrane Database Syst Rev. 2012. Update in: Cochrane Database Syst Rev. 2019 Sep 17;9:CD003248. doi: 10.1002/14651858.CD003248.pub4. PMID: 22895933 Updated.
References
References to studies included in this review
Aladangady 2006 {published and unpublished data}
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- Armanian M. Is "delayed umbilical cord clamping" beneficial for premature newborns?. en.search.irct.ir/view/22000 (first received 14 February 2015).
Backes 2016 {published data only}
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- Backes C, Copeland K, Iams JP, Giannone PJ, Bauer JA. Impact of delayed umbilical cord clamping at the limits of viability. International Conference of Transitional Care; 2013 19th April; Birmingham, UK. 2013.
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- Backes CH, Huang H, Luce WA, Schanbacher BL, Backes KA, Ehrenberg H, et al. Postnatal progenitor cells pools and delayed umbilical cord clamping at the limits of viability. Pediatric Academic Societies and Asian Society for Pediatric Research Joint Meeting; 2011 April 30‐May 3; Denver, Colorado, USA. 2011:441.
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Baenziger 2007 {published data only}
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CORD Pilot 2018 {published data only}
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Dai 2014 {published data only}
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Das 2018 {published data only}
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Datta 2017 {published data only}
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Dhaliwal 2014 {published data only}
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Dipak 2017 {published data only}
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- Kumar Dipak N, Nanavati RN, Kabra NK, Srinivasan A, Ananthan A. Effect of delayed cord clamping on hematocrit, and thermal and hemodynamic stability in preterm neonates: A randomized controlled trial. Indian Pediatrics 2017;54(2):112‐5. - PubMed
Dong 2016 {published data only}
Elimian 2014 {published data only}
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- Elimian A, Goodman J, Escobedo M, Nightingale L, Knudtson E, Williams M. A randomized controlled trial of immediate versus delayed cord clamping in the preterm neonate. American Journal of Obstetrics and Gynecology 2013;208(1 Suppl):S22. - PubMed
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El‐Naggar 2016 {published data only}
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- El‐Naggar W, Simpson D, Hussain A, Armson A, Dodds L, Warren A, et al. The effect of umbilical cord milking on hemodynamic status of preterm infants: a randomized controlled trial. Journal of Paediatrics and Child Health 2016;21:e88.
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Gokmen 2011 {published data only}
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- Gokmen Z, Ozkiraz S, Tarcan A, Kozanoglu I, Ozcimen EE, Ozbek N. Effects of delayed umbilical cord clamping on peripheral blood hematopoietic stem cells in premature neonates. Journal of Perinatal Medicine 2011;39:323‐9. - PubMed
Hofmeyr 1988 {published data only}
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Hofmeyr 1993 {published data only}
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Hosono 2008 {published data only}
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- Hosono S, Mugishima H, Fujita H, Hosono A, Minato M, Okada T, et al. Umbilical cord milking reduces the need for red cell transfusions and improves neonatal adaptation in infants born less than 29 weeks' gestation: a randomized controlled trial. Archives of Disease in Childhood. Fetal and Neonatal Edition 2008;93:F14‐9. - PubMed
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Hosono 2015 {published data only}
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Josephsen 2014 {published data only}
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Katheria 2014 {published data only}
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Katheria 2015 {published data only}
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- Katheria A, NCT03476980. Two year developmental follow‐up for premature infants receiving milking or delayed cord clamping: PREMOD2. https://clinicaltrials.gov/ct2/show/NCT03476980 (first received 26 March 2018). [NCT03476980]
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Kilicdag 2016 {published data only}
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Kinmond 1993 {published and unpublished data}
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- Kinmond S, Hudson IR, Aitchison T, Holland BM, Turner TL, Jones JG, et al. Placento‐fetal transfusion in preterm infants. Proceedings of the Neonatal Society; 1990 March; London, UK. 1990.
Krueger 2015 {published data only}
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Kugelman 2007 {published data only}
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Kumar 2015 {published data only}
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Malik 2013 {published data only}
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March 2013 {published data only}
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McDonnell 1997 {published and unpublished data}
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Mercer 2003 {published and unpublished data}
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Mercer 2006 {published and unpublished data}
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Mercer 2016 {published data only}
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Nelle 1998 {published and unpublished data}
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Rabe 2000 {published and unpublished data}
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Rana 2017 {published data only}
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Ranjit 2015 {published data only}
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Sekhavat 2008 {published data only}
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Shi 2017 {published data only}
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- Shi W, Peng J, Chen N. Effect of delayed cord clamping on outcome of delivery. Henan Journal of Preventive Medicine 2017; Vol. 28:85‐7, 93.
Strauss 2008 {published data only}
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- Strauss RG, Mock MM, Johnson K, Mock NI, Cress G, Knosp L, et al. Circulating rbc volume, measured with biotinylated rbcs, is superior to the hct to document the hematologic effects of delayed versus immediate umbilical cord clamping in preterm neonates. Transfusion 2003;43:1168‐72. - PubMed
Tarnow‐Mordi 2017 {published data only}
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- Popat H, Galea C, Evans N, Lingwood B, Colditz P, Halliday R, et al. Effect of delayed cord clamping on cerebral oxygenation in preterm infants <30 weeks gestation. Journal of Paediatrics and Child Health 2017;53(Suppl 2):80.
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- Popat H, Robledo KP, Sebastian L, Evans N, Gill A, Kluckow M, et al. Effect of delayed cord clamping on systemic blood flow: a randomized controlled trial. Journal of Pediatrics. ACTRN12610000633088 2017; Vol. 178:81‐6.e2. - PubMed
Tiemersma 2015 {published data only}
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- Tiemersma S, Heistein J, Ruijne R, Lopez G, Lobenstei J, Rheenen P. Delayed cord clamping in South African neonates with expected low birthweight: a randomised controlled trial. Tropical Medicine & International Health 2015;20(2):177‐83. - PubMed
Ultee 2008 {published data only}
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- Ultee CA, Deure J, Swart J, Lasham C, Baar AL. Delayed cord clamping in preterm infants delivered at 34‐36 weeks' gestation: a randomised controlled trial. Archives of Disease in Childhood. Fetal and Neonatal Edition 2008;93:F20‐3. - PubMed
References to studies excluded from this review
Aitchison {unpublished data only}
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- Aitchison T, Beattie B, Cameron A, Halliday H, Holland B, Wardrop C. Placento‐fetal (Autologous) transfusion (PFTx) at birth in infants born preterm: a randomised, controlled trial. Personal communication.
Akhtar 2014 {published data only}
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- Akhtar S, Bora R. Effect of umbilical cord milking on haemoglobin & serum ferritin levels at six months of age in infants ‐ a randomized controlled trial. Pediatric Academic Societies and Asian Society for Pediatric Research Joint Meeting; 2014 May 3‐6; Vancouver, Canada. 2014:Abstract no: 2945.604.
Ashish 2017 {published data only}
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- Kc A, Rana N, Malqvist M, Jarawka Ranneberg L, Subedi K, Andersson O. Effects of delayed umbilical cord clamping vs early clamping on anemia in infants at 8 and 12 months: a randomized clinical trial. JAMA Pediatrics 2017; Vol. 171, issue 3:264‐70. - PubMed
Chopra 2016 {published data only}
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- Chopra A, Kier N, Garg P, Thakur A. [4110.102] Effect of delayed versus early cord clamping on neonatal outcomes and iron stores at 3 months in small for gestational age babies ‐ a randomized controlled trial. Pediatric Academic Societies Annual Meeting; 2016 April 30 ‐ May 3; Baltimore, USA. 2016.
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- Chopra A, Kler N, Thakur A, Garg P. Delayed vs early cord clamping in small for gestational age infants >35 weeks gestation: A randomized controlled trial. Journal of Pediatric Gastroenterology and Nutrition 2016; Vol. 62, issue Suppl 1:657.
Frank 1967 {published data only}
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- Frank DJ, Gabriel M. Timing of cord ligation and newborn respiratory distress. American Journal of Obstetrics and Gynecology 1967;97:1142‐4. - PubMed
Garabedian 2016 {published data only}
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- Garabedian C, Rakza T, Drumez E, Poleszczuk M, Ghesquiere L, Wibaut B, et al. Benefits of delayed cord clamping in red blood cell alloimmunization. Pediatrics 2016;137(3):e20153236. - PubMed
Ibrahim 2000 {published data only}
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- Ibrahim HM, Krouskop RW, Lewis DF, Dhanireddy R. Placental transfusion: umbilical cord clamping in preterm infants. Journal of Perinatology 2000;120:351‐4. - PubMed
Katheria 2016 {published data only}
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Kattwinkel 2016 {published data only}
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- Kattwinkel J. VentFiirst: A multicenter RCT of assisted ventilation during delayed cord clamping for extremely preterm infants. https://clinicaltrials.gov/ct2/show/record/NCT02742454 2016.
Mungkornkaew 2015 {published data only}
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- Mungkornkaew S, Siwadune T. The difference of hematocrit in term and preterm vaginal births in different timing of delayed cord clamping. Thai Journal of Obstetrics and Gynaecology 2015;23:223‐30.
Narendra 1998 {published data only}
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- Narendra A, Beckett C, Aitchinson T, Kyle E, Coutts J, Turner T, et al. Is it possible to promote placental transfusion (PTFx) at preterm delivery?. Pediatric Research 1998;44:454A.
Ruangkit 2015 {published data only}
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- Ruangkit C, Moroney V, Viswanathan S, Bhola M. [1175.8] Safety of delayed umbilical cord clamping in multiple and singleton premature infants ‐ a quality improvement study. Pediatric Academic Societies Annual Meeting; 2015 April 25‐28; San Diego, California. 2015. - PubMed
Saigal 1972 {published data only}
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- Saigal S, O'Neill A, Surainder Y, Chua LB, Usher R. Placental transfusion and hyperbilirubinemia in the premature. Pediatrics 1972;49(3):406‐19. - PubMed
Saigal 1977 {published data only}
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- Saigal S, Usher RH. Symptomatic neonatal plethora. Biology of the Neonate 1977;32:62‐72. - PubMed
Spears 1966 {published data only}
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- Spears RL, Anderson GV, Brotman S, Farrier J, Kwan J, Masto A, et al. The effect of early vs late cord clamping on signs of respiratory distress. American Journal of Obstetrics and Gynecology 1966;95:564‐8. - PubMed
Taylor 1963 {published data only}
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- Taylor P, Bright N, Birchard E. Effect of early vs delayed clamping of the umbilical cord on the clinical condition of the newborn infant. American Journal of Obstetrics and Gynecology 1963;86:893‐8. - PubMed
Tipwaree 2015 {published data only}
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- Tipwaree S. The effect of umbilical cord milking in term infants followed by cesarean section delivery: a randomized controlled trial. clinicaltrials.in.th/index.php?tp=regtrials&menu=trialsearch&sme... (first received 28 May 2015).
Yadav 2015 {published data only}
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- Yadav AK, Upadhyay A, Gothwal S, Dubey K, Mandal U, Yadav CP. Comparison of three types of intervention to enhance placental redistribution in term newborns: randomized control trial. Journal of Perinatology 2015;35:720‐4. - PubMed
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- Yadav AK, Upadhyay A, Jaiswal V, Gupta NK, Sharma RS, Gothwal S, et al. [2765.5] To compare the effect of delayed cord clamping, umbilical cord milking and delayed cord clamping with milking on haematological parameters in term neonates. Pediatric Academic Societies Annual Meeting; 2015 April 25‐28; San Diego, California. 2015.
Yasmeen 2014 {published data only}
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- Yasmeen S, Shahidullah M, Mannan MA, Dey AC, Chowdhury RB, Haque AQMS, et al. Iron status in early versus delayed cord clamping groups of preterm neonates delivered in a tertiary level hospital. Journal of Armed Forces Medical College Bangladesh 2014;10:62‐5.
Zisovska 2008 {published data only}
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- Zisovska E, Lazarevska L, Spasova L, Zivkovik J. The effect of delayed cord clamping on the need for blood transfusion. Transfusion Alternatives in Transfusion Medicine 2008;10(Suppl 1):25, Abstract no. P17.
References to studies awaiting assessment
Das 2018a {published data only}
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- Das B, Sundaram V, Tarnow‐Mordi W, Ghadge A, Dhaliwal LK, Kumar P. Placental transfusion in preterm neonates of 30‐33 weeks' gestation: a randomized controlled trial. Journal of Perinatology 2018;38(5):496‐504. [CTRI/2014/02/004414] - PubMed
El‐Naggar 2018 {published data only}
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- El‐Naggar W, Simpson D, Hussain A, Armson A, Dodds L, Warren A, et al. Cord milking versus immediate clamping in preterm infants: a randomised controlled trial. Archives of Disease in Childhood. Fetal and Neonatal Edition 14 June 2018 [Epub ahead of print]. - PubMed
Hu 2015 {published data only}
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- Hu X, Xu X. The Effects of Different Cord Clamping Time in Preterm Infants by Vaginal Delivery [Master's Degree Thesis]. Zhejiang University, 2015.
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- Hu X, Xu X. The effects of different cord clamping time in vaginal birth preterm infants. 31st International Confederation of Midwives Triennial Congress. Midwives ‐ Making a Difference in the World; 2017 June 18‐22; Toronto, Canada. 2017:Abstract no: A12.02.
Hua 2010 {published data only}
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- Hua SP, Zhang HY, Zhou H, Zhang SH, Chen W, Xie CL. Effect of time of clamping umbilical cord on outcome of mothers and newborns. Journal of Hainan Medical College 2010;16:1572‐5.
Kazemi 2017 {published data only}
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- Kazemi MV, Akbarianrad Z, Zahedpasha Y, Haghshenas Mojaveri M, Mehraein R. Effects of delayed cord clamping on intraventricular hemorrhage in preterm infants. Iranian Journal of Pediatrics 2017;27(5):e6570.
Leal 2018 {published data only}
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- Leal VL, Bueno LP, Vilaplana LC, Montero EN, Blanco MM, Romero CF, et al. Effect of milking maneuver in preterm infants: a randomized controlled trial. Fetal Diagnosis and Therapy 2018 [Epub ahead of print]. - PubMed
Li 2018 {published data only}
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- Li J, Wang W, Luo D, Dai Q‐L, Gan X‐Q, Yu B. Does intact umbilical cord milking increase infection rates in preterm infants with premature prolonged rupture of membranes?. Journal of Maternal‐Fetal and Neonatal Medicine 2018 [Epub ahead of print]. - PubMed
Medina 2014 {published data only}
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- Medina IMF. Late clamping of the umbilical cord in premature neonates: The real haemodynamic benefits. Enfermeria Clinica 2014;24(5):305‐8. - PubMed
Ram Mothan 2018 {published data only}
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- Ram Mohan G, Shashidhar A, Chandrakala BS, Nesargi S, Suman Rao PN. Umbilical cord milking in preterm neonates requiring resuscitation: a randomized controlled trial. Resuscitation 5 July 2018 [Epub ahead of print]. - PubMed
Song 2017 {published data only}
Wang 2018 {published data only}
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- Wang M, Mercer JS, Padbury JF. Delayed cord clamping in infants with suspected intrauterine growth restriction. Journal of Pediatrics 2018; Vol. 201:264‐8. - PubMed
Weeks 2018 {published data only}
References to ongoing studies
Aghai 2018 {published data only}
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- Aghai ZH, Katheria A, NCT03657394. Short‐term outcomes of umbilical cord milking in term and late preterm neonates who are depressed at birth. https://clinicaltrials.gov/ct2/show/NCT03657394 (first received 5 September 2018). [NCT03657394]
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- Aghai ZH, Katheria A, NCT03681314. Long‐term outcomes of umbilical cord milking in term and late preterm neonates who are depressed at birth. https://clinicaltrials.gov/ct2/show/NCT03681314 (first received 24 September 2018). [NCT03681314]
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- Aghai ZH, Katheria A, NCT03682042. Long‐term outcomes of umbilical cord milking in term and late preterm neonates with moderate to severe hypoxic ischemic encephalopathy. https://clinicaltrials.gov/ct2/show/NCT03682042 (first received 24 September 2018). [NCT03682042]
Allam 2018 {published data only}
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- Allam N, ACTRN12618000758202p. Delayed fetal cord clamping in premature labour: the effect on fetal haemoglobin, bilirubin and neonatal death, maternal haemoglobin, neonatal ICU admission and postpartum haemorrhage. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=1261... (first received 7 May 2018).
Al‐Wassia 2016 {published data only}
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- NCT02996799, Al‐Wassia H. Efficacy and safety of deferred umbilical cord clamping compared to umbilical cord milking in preterm infants: a randomized clinical trial. clinicaltrials.gov/ct2/show/record/NCT02996799 (first received 3 December 2016).
Anusha 2017 {published data only}
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- Anusha S, CTRI/2017/01/007671. Early cord clamping versus delayed cord clamping in very low birth weight neonates. ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=16653 (first received 11 January 2017).
Bhriguvanshi 2017 {published data only}
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- Bhriguvanshi A. The effects of umbilical cord milking in neonates requiring resuscitation at birth: a randomized controlled trial. ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=18641 (first received 24 August 2017).
Bienstock 2011 {published data only}
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- Bienstock J. Milking the umbilical cord versus immediate clamping in pre‐term infants <33 weeks: a randomized controlled trial. ClinicalTrials.gov (http://clinicaltrials.gov/) [accessed 3 July 2015] 2011.
Carroli 2017 {published data only}
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- Carroli G, ISRCTN12219110. Early compared to delayed umbilical cord clamping in very small prematurely born babies: a study to know which one is better for infant health. isrctn.com/ISRCTN12219110 (first received 30 March 2017).
Chamnanvanakij 2015 {published data only}
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- Chamnanvanakij S. Effect of delayed cord clamping versus cord milking in infants born at <34 weeks’ gestation: a randomized controlled trial. Thai Clinical Trials Registry (http://www.clinicaltrials.in.th/) [accessed 3 July 2015] [accessed 3 July 2015] 2015.
Dempsey 2016 {published data only}
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- Dempsey E, ISRCTN92719670. Clamping the umbilical cord in premature deliveries (CUPID). http://www.isrctn.com/ISRCTN92719670 (first received 25 January 2016).
De Paco Matallana 2013 {published data only}
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- Paco Matallana C. DElayed COrd CLAmping versus early cord clamping in preterm infants born between 24 and 34 weeks. isrctn.com/ISRCTN66018314 (first received 6 October 2013).
Driggers 2013 {published data only}
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- Driggers RW. Delayed umbilical cord clamping versus cord milking in preterm neonate ‐ a randomized, controlled trial. ClinicalTrials.gov (http://clinicaltrials.gov/) [accessed 3 July 2015] 2013.
Gomaa 2017 {published data only}
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- Gomaa M, NCT03147846. The hematologic impact of umbilical cord milking versus deferred cord clamping in premature neonates. a randomized controlled trial. clinicaltrials.gov/ct2/show/record/NCT03147846 (first received 10 May 2017).
Gupta 2018 {published data only}
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- Gupta A, CTRI/2018/08/015204. Early versus delayed cord clamping in IUGR preterms a randomised controlled study. http://www.ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=25064 (first received 6 August 2018).
Haghshenas 2014 {published data only}
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- Haghshenas M. Comparative study of the effect of delayed versus early cord clamping on the incidence of intra ventricular hemorrhage in preterm neonate. Iranian Registry of Clinical Trials (http://www.irct.ir/) [accessed 3 July 2015] 2014.
Hao 2018 {published data only}
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- Hao P, ChiCTR1800018366. Effect of delayed cord clamping versus umbilical cod milking on cerebral blood flow in preterm infant: a randomized, double‐blind controlled trial. http://www.chictr.org.cn/showproj.aspx?proj=30981 (first received 13 September 2018).
Hemmati 2014 {published data only}
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- Hemmati F. Comparing the effect of delayed versus immediate cord clamping on the incidence of intraventricular hemorrhage (IVH) in preterm neonates with gestational age =34 weeks in Hafez & Zeynab hospitals from September 2012 to December 2013. Iranian Registry of Clinical Trials (http://www.irct.ir/) [accessed 3 July 2015] 2014.
Holland 1998 {published data only (unpublished sought but not used)}
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- Holland BM. Placento‐fetal (autologous) transfusion at birth in infants born preterm: a randomised controlled trial. Personal communication 1998.
Isac 2017 {published data only}
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- Isac M. Effect of umbilical cord milking of late preterm and term infants on maternal and neonatal outcomes in a tertiary care hospital in South India: a randomized control trial. ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=19631 (first received 3 October 2017).
Jomjak 2018 {published data only}
-
- Jomjak P, TCTR20180817001. To compare the effects of delayed versus early cord clamping on neonatal outcomes in preterm (gestational age at >24 weeks to 36+6 weeks) and maternal outcomes. http://www.clinicaltrials.in.th/index.php?tp=regtrials&menu=trialsea... (first received 14 August 2018).
Katheria 2017 {published data only}
-
- Katheria A, NCT03019367. Premature infants receiving milking or delayed cord clamping: randomized controlled multicenter non‐inferiority trial. clinicaltrials.gov/ct2/show/NCT03019367 (first received 12 January 2017).
-
- Katheria A, NCT03145142. PREMOD2 NIRS substudy ‐ a randomized trial of cerebral oxygen saturation in infants randomized to umbilical cord milking or delayed cord clamping. clinicaltrials.gov/ct2/show/record/NCT03145142 (first received 9 May 2017).
Katheria 2018 {published data only}
-
- Katheria A, NCT03621943. Umbilical cord milking in non‐vigorous infants developmental followup (MINVIFU). https://clinicaltrials.gov/ct2/show/NCT03621943 (first received 9 August 2018). [NCT03621943]
-
- Katheria A, NCT03621956. Umbilical cord milking in non‐vigorous infants ‐ NIRS Sub‐study (MINVI_NIRS). https://clinicaltrials.gov/ct2/show/NCT03621956 (first received 9 August 2018). [NCT03621956]
-
- Katheria A, NCT03631940. Umbilical cord milking in non‐vigorous infants. https://clinicaltrials.gov/ct2/show/NCT03631940 (first received 15 August 2018). [NCT03631940]
Liu 2018 {published data only}
-
- Liu J, ChiCTR1800017865. Delayed cord clamping prevents respiratory distress of infants delivered by selective cesarean section in between 34‐38 weeks of gestational age, a randomized controlled trial. http://www.chictr.org.cn/showproj.aspx?proj=30199 (1first received 8 August 2018). [ChiCTR1800017865]
Martin 2013 {published data only}
-
- Martin J. Timing of umbilical cord clamping after vaginal or cesarean preterm birth. ClinicalTrials.gov (http://clinicaltrials.gov/) [accessed 4 June 2015] 2013.
Mirzaeian 2018 {published data only}
-
- Mirzaeian S, IRCT20180201038586N1. Investigation and comparison of neonatal complications of two methods of umbilical cord milking and early cord clamping in neonates. https://en.irct.ir/trial/29424 (first received 9 March 2018).
Nour 2018a {published data only}
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- Nour I, NCT03731546. Effect of delayed cord clamping in preterm neonates with placental insufficiency. https://clinicaltrials.gov/ct2/show/NCT03731546 (first received 6 November 2018). [NCT03731546]
Nour 2018b {published data only}
-
- Nour I, NCT03731611. Impact of umbilical cord milking in preterm neonates with placental insufficiency. https://clinicaltrials.gov/ct2/show/NCT03731611 (first received 6 November 2018). [NCT03731611]
Panichkul 2015 {published data only}
-
- Panichkul P. Effects of delayed versus early cord clamping in late preterm infants: a randomized controlled trial. Thai Clinical Trials Registry http://www.clinicaltrials.in.th/ [accessed 28 June 2015] 2015.
Perlman 2015 {published data only}
-
- Perlman J. The effects of delayed cord clamping on postnatal circulatory status in preterm neonates. ClinicalTrials.gov (http://clinicaltrials.gov/) [accessed 3 July 2015] 2015.
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- Spaight M, McKinsey S, Perlman J. [375] A randomized study of delayed cord clamping (DCC) in preterm neonates; preliminary observations. Pediatric Academic Societies Annual Meeting; 2016 April 30 ‐ May 3; Baltimore, USA. 2016.
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- Spaight M, McKinsey S, Perlman J. [4110.103] A randomized study of delayed cord clamping (DCC) in preterm neonates; preliminary observations. Pediatric Academic Societies Annual Meeting; 2016 April 30 ‐ May 3; Baltimore, USA. 2016.
Ping 2010 {published data only}
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- Ping HS. Immediate vs delayed cord clamping on newborns (no). ClinicalTrials.gov (http://clinicaltrials.gov/) (accessed 12.05.2010) 2010.
Puiggros 2014 {published data only}
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- Puiggros MD. Umbilical cord milking compared with delayed cord clamping to increase placental transfusion in preterm infants less than 34 weeks' gestation born by cesarean section. randomised clinical trial. ClinicalTrials.gov (http://clinicaltrials.gov/) [accessed 3 July 2015] 2014.
Ruangkit 2017 {published data only}
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- Ruangkit C, TCTR20170125001. A randomized controlled trial of immediate versus delayed umbilical cord clamping in preterm infants of multiple births. clinicaltrials.in.th/index.php?tp=regtrials&menu=trialsearch&sme... (first received 25 January 2017).
Shahgheibi 2018 {published data only}
-
- Shahgheibi S, IRCT20141208020249N2. The delayed umbilical cord clamping effects on early outcome in preterm neonates. https://en.irct.ir/trial/17924 (first received 1 July 2018).
Smith 2014 {published data only}
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- Smith K. Delayed clamping and milking the umbilical cord in preterm infants. ClinicalTrials.gov [accessed 25 May 2014] 2014.
Tanthawat 2017 {published data only}
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- Tanthawat S, TCTR20170201003. The effect of one‐time umbilical cord milking and early cord clamping in preterm infants: a randomized controlled trial (one‐time umbilical cord milking). clinicaltrials.in.th/index.php?tp=regtrials&menu=trialsearch&sme... (first received 1 February 2017).
Thukral 2016 {published data only}
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- Thukral A, CTRI/2016/11/007470. Comparison of umbilical cord milking with delayed cord clamping in late preterm and term neonates: randomized control trial. www.ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=14204 (first received 16 November 2016).
Upahyay 2014 {published data only}
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- Upahyay A. Effect of umbilical cord milking on hematological parameters at 6 weeks of life in pre term newborns: a randomised control trial. ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=10367 (first received 11 December 2014).
Varanattu 2017 {published data only}
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- Varanattu M, NCT03200301. Effect of intact umbilical cord milking versus immediate cord clamping on neonatal outcomes and first year neurodevelopmental outcomes in very preterm infants ‐ a randomised controlled trial. clinicaltrials.gov/ct2/show/record/NCT03200301 (first received 27 June 2017).
Whitehead 2014 {published data only}
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- Whitehead V. Effects of delayed cord clamp and/or indomethacin on preterm infant brain injury. clinicaltrials.gov/ct2/show/NCT02221219 (first received 20 August 2014).
Xie 2017 {published data only}
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- Xie L, NCT03023917. The study on umbilical cord milking to prevent and decrease the severity of anemia in preterms‐‐a multi‐center randomized controlled trial. clinicaltrials.gov/ct2/show/record/NCT03023917 (first received 18 January 2017).
Yared 2015 {published data only}
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- Yared E, NCT02337088. Delayed cord clamping at 30 vs. 60 seconds for very low birth weight infants: a randomized controlled trial. clinicaltrials.gov/ct2/show/NCT02337088 (first received 13 January 2015).
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