Umbilical Cord Management at Term and Late Preterm Birth: …

Gomersall J, Berber S, Middleton P, et al. Umbilical Cord Management at Term and Late Preterm Birth: A Meta-analysis. Pediatrics. 2021;147(3):e2020015404. doi:10.1542/peds.2020-015404

Context
The International Liaison Committee on Resuscitation prioritized scientific review of umbilical cord management at term and late preterm birth.

Objective
To assess effects of umbilical cord management strategies (clamping timing and cord milking) in infants ≥34 weeks’ gestational age.

Data sources
Cochrane Central Register of Controlled Trials, Medline, PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, and trial registries searched July 2019.

Study selection
Two authors independently assessed eligibility of randomized controlled trials.

Data extraction
Two authors independently extracted data and assessed evidence certainty (Grading of Recommendations Assessment, Development and Evaluations).

Results
We identified 46 studies (9159 women and their infants) investigating 7 comparisons. Compared with early cord clamping (ECC) <30 seconds, delayed cord clamping (DCC) ≥30 seconds (33 studies), intact-cord milking (1 study), and cut-cord milking (2 studies) probably improve hematologic measures but may not affect survival without neurodisability, anemia in early infancy, or maternal postpartum hemorrhage. No differences in major neonatal morbidities are seen in studies comparing methods of optimizing placental transfusion (DCC versus cut-cord milking [3 studies], longer delays in clamping [7 studies], or physiologic parameters [3 studies]). Strategies that promote increased placental transfusion may be associated with greater phototherapy use. Evidence for all outcomes was low or very low certainty.

Limitations
Incompleteness and low certainty of findings limit applicability.

Conclusions
Compared with ECC, DCC or cord milking increases hemoglobin and hematocrit immediately after birth in infants ≥34 weeks’ gestational age. The uncertain effects of DCC and cord milking compared with ECC on major morbidities limit usefulness of available evidence for policy and practice.

Disponível Em: <https://pubmed.ncbi.nlm.nih.gov/>