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Meta-Analysis
. 2025 Apr;97(5):1481-1491.
doi: 10.1038/s41390-024-03496-7. Epub 2024 Sep 2.

Umbilical cord management in newborn resuscitation: a systematic review and meta-analysis

Gréta Sz Major  1   2 , Vivien Unger  1   3 , Rita Nagy  1   2 , Márk Hernádfői  1   4 , Dániel S Veres  1   5 , Ádám Zolcsák  1   5 , Miklós Szabó  1   6 , Miklós Garami  1   7 , Péter Hegyi  1   8   9 , Péter Varga  1   6   10 , Ákos Gasparics  11   12   13
Affiliations
Meta-Analysis

Umbilical cord management in newborn resuscitation: a systematic review and meta-analysis

Gréta Sz Major et al. Pediatr Res. 2025 Apr.

Abstract

Background: Evidence supporting the benefits of delayed cord clamping is increasing; however, there is no clear recommendation on cord management during newborn resuscitation. This study aimed to investigate the effects of resuscitation initiated with an intact umbilical cord, hypothesizing it is a safe stabilization procedure that improves neonatal outcomes.

Methods: Systematic search was conducted in MEDLINE, Embase, CENTRAL, and Web of Science from inception to March 1, 2024. Eligible articles compared neonatal outcomes in newborns receiving initial stabilization steps before and after cord clamping.

Results: Twelve studies met our inclusion criteria, with six RCTs included in the quantitative analysis. No statistically significant differences were found in delivery room parameters, in-hospital mortality, or neonatal outcomes between the examined groups. However, intact cord resuscitation group showed higher SpO2 at 5 min after birth compared to cord clamping prior to resuscitation group (MD 6.67%, 95% CI [-1.16%, 14.50%]). There were no significant differences in early complications of prematurity (NEC ≥ stage 2: RR 2.05, 95% CI [0.34, 12.30], IVH: RR 1.25, 95% CI [0.77, 2.00]).

Conclusion: Intact cord management during resuscitation appears to be a safe intervention; its effect on early complications of prematurity remains unclear. Further high-quality RCTs with larger patient numbers are urgently needed.

Impact: Initiating resuscitation with an intact umbilical cord appears to be a safe intervention for newborns. No statistically significant differences were found in delivery room parameters, in-hospital mortality, and neonatal outcomes between the examined groups. The utilization of specialized resuscitation trolleys appears to be promising to reduce the risk of intraventricular hemorrhage in preterm infants. Further high-quality RCTs with larger sample sizes are urgently needed to refine recommendations.

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Conflict of interest statement

Competing interests: There are no potential conflicts of interest to declare. Ethics approval and consent to participate: No ethical approval was required for this systematic review with meta-analysis, as all data were already published in peer-reviewed journals. None of the patients was involved in the design, conduct or interpretation of our study.

Figures

Fig. 1
Fig. 1. Forest plot representing the risk ratio of in-hospital mortality in infants who received ICR or CC prior to resuscitation after birth.
RR risk ratio, 95% CI 95% confidence interval, CC cord clamping.
Fig. 2
Fig. 2. Forest plot representing the mean difference of SpO2 after birth in infants who received ICR or CC prior to resuscitation after birth.
a Forest plot representing the mean difference of SpO2 at 5 min after birth in infants who received ICR or CC prior to resuscitation after birth. b Forest plot representing the mean difference of SpO2 at 10 min after birth in infants who received ICR or CC prior to resuscitation after birth. SpO2 oxygen saturation level by pulse oximetry, min minutes, MD mean difference, SD standard deviation, 95% CI 95% confidence interval, CC cord clamping.
Fig. 3
Fig. 3. Forest plot representing the mean difference of temperature at admission to the NICU in infants who received ICR or CC prior to resuscitation after birth.
NICU neonatal intensive care unit, MD mean difference, SD standard deviation, 95% CI 95% confidence interval, CC cord clamping.
Fig. 4
Fig. 4. Forest plot representing the risk ratio of IVH in infants who received ICR or CC prior to resuscitation after birth.
a Forest plot representing the risk ratio of all grades of IVH in infants who received ICR or CC prior to resuscitation after birth. b Forest plot representing the risk ratio of severe IVH (≥grade 3) in infants who received ICR or CC prior to resuscitation after birth. IVH intraventricular hemorrhage, RR risk ratio, 95% CI 95% confidence interval, CC cord clamping.
Fig. 5
Fig. 5. Forest plot representing the risk ratio of NEC ≥ stage 2 in infants who received ICR or CC prior to resuscitation after birth.
NEC necrotizing enterocolitis, RR risk ratio, 95% CI 95% confidence interval, CC cord clamping.
Fig. 6
Fig. 6. Forest plot representing the risk ratio of ROP requiring treatment in infants who received ICR or CC prior to resuscitation after birth.
ROP retinopathy of the prematurity, RR risk ratio, 95% CI 95% confidence interval, CC cord clamping.
See this image and copyright information in PMC

References

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