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Meta-Analysis
. 2021 Feb 8;16(2):e0246353.
doi: 10.1371/journal.pone.0246353. eCollection 2021.

Interventions to minimize blood loss in very preterm infants-A systematic review and meta-analysis

Emma Persad  1   2 , Greta Sibrecht  3 , Martin Ringsten  4 , Simon Karlelid  4 , Olga Romantsik  4 , Tommy Ulinder  4 , Israel Júnior Borges do Nascimento  5   6 , Maria Björklund  7 , Anneliese Arno  8 , Matteo Bruschettini  4   9
Affiliations
Meta-Analysis

Interventions to minimize blood loss in very preterm infants-A systematic review and meta-analysis

Emma Persad et al. PLoS One. .

Abstract

Blood loss in the first days of life has been associated with increased morbidity and mortality in very preterm infants. In this systematic review we included randomized controlled trials comparing the effects of interventions to preserve blood volume in the infant from birth, reduce the need for sampling, or limit the blood sampled. Mortality and major neurodevelopmental disabilities were the primary outcomes. Included studies underwent risk of bias-assessment and data extraction by two review authors independently. We used risk ratio or mean difference to evaluate the treatment effect and meta-analysis for pooled results. The certainty of evidence was assessed using GRADE. We included 31 trials enrolling 3,759 infants. Twenty-five trials were pooled in the comparison delayed cord clamping or cord milking vs. immediate cord clamping or no milking. Increasing placental transfusion resulted in lower mortality during the neonatal period (RR 0.51, 95% CI 0.26 to 1.00; participants = 595; trials = 5; I2 = 0%, moderate certainty of evidence) and during first hospitalization (RR 0.70, 95% CI 0.51, 0.96; 10 RCTs, participants = 2,476, low certainty of evidence). The certainty of evidence was very low for the other primary outcomes of this review. The six remaining trials compared devices to monitor glucose levels (three trials), blood sampling from the umbilical cord or from the placenta vs. blood sampling from the infant (2 trials), and devices to reintroduce the blood after analysis vs. conventional blood sampling (1 trial); the certainty of evidence was rated as very low for all outcomes in these comparisons. Increasing placental transfusion at birth may reduce mortality in very preterm infants; However, extremely limited evidence is available to assess the effects of other interventions to reduce blood loss after birth. In future trials, infants could be randomized following placental transfusion to different blood saving approaches. Trial registration: PROSPERO CRD42020159882.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. PRISMA flow diagram.
Fig 2
Fig 2. Methodological quality graph.
Authors’ judgements about each methodological quality item presented as percentages across all included studies.
Fig 3
Fig 3. Methodological quality summary.
Authors’ judgements about each methodological quality item for each included study.
Fig 4
Fig 4. Forest plot of comparison: 1 delayed cord clamping or milking vs. immediate cord clamping or no milking, outcome: 1.1 all-cause neonatal mortality (first 28 days).
Fig 5
Fig 5. Forest plot of comparison: 1 delayed cord clamping or milking vs. immediate cord clamping or no milking, outcome: 1.2 all-cause mortality during initial hospitalization.
Fig 6
Fig 6. Forest plot of comparison: 1 delayed cord clamping or milking vs. immediate cord clamping or no milking, outcome: 1.17 concentration of total hemoglobin (Hb)–day 1–7 [g/dl].
Fig 7
Fig 7. Funnel plot of comparison: 1 delayed cord clamping or milking vs. immediate cord clamping or no milking, outcome: 1.1 all-cause neonatal mortality (first 28 days).
Fig 8
Fig 8. Funnel plot of comparison: 1 delayed cord clamping or milking vs. immediate cord clamping or no milking, outcome: 1.2 all-cause mortality during initial hospitalization.
See this image and copyright information in PMC

References

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