Summary of findings for the main comparison. DCC with immediate neonatal care after cord clamping compared to ECC (subgroup analysis by gestation) for health problem or population.
| DCC with immediate neonatal care after cord clamping compared to ECC (subgroup analysis by gestation) for health problem or population | ||||||
| Patient or population: babies born preterm, and their mothers Setting: hospital births mostly in high‐income countries Intervention: delayed cord clamping (DCC) with immediate neonatal care after cord clamping Comparison: early cord clamping (ECC) | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with ECC (subgroup analysis by gestation) | Risk with DCC with immediate neonatal care after cord clamping | |||||
| Death of baby (up to discharge) | Study population | RR 0.73 (0.54 to 0.98) | 2680 (20 RCTs) | ⊕⊕⊕⊝ MODERATE 1 2 | ||
| 74 per 1000 | 54 per 1000 (40 to 72) | |||||
| Death or neurodevelopmental impairment in early years | Study population | ‐ | (0 studies) | ‐ | ||
| see comment | see comment | |||||
| Severe intraventricular haemorrhage (IVH grades 3, 4) | Study population | RR 0.94 (0.63 to 1.39) | 2058 (10 RCTs) | ⊕⊕⊝⊝ LOW 3 4 | ||
| 48 per 1000 | 45 per 1000 (30 to 66) | |||||
| Intraventricular haemorrhage (IVH, all grades) | Study population | RR 0.83 (0.70 to 0.99) | 2333 (15 RCTs) | ⊕⊕⊕⊕ HIGH 5 6 | ||
| 187 per 1000 | 155 per 1000 (131 to 185) | |||||
| Periventricular leukomalacia (PVL) | Study population | RR 0.58 (0.26 to 1.30) | 1544 (4 RCTs) | ⊕⊕⊝⊝ LOW 7 | ||
| 22 per 1000 | 13 per 1000 (6 to 28) | |||||
| Chronic lung disease (CLD) ‐ oxygen supplement at 36 weeks (corrected for gestation) | Study population | RR 1.04 (0.94 to 1.14) | 1644 (6 RCTs) | ⊕⊕⊕⊕ HIGH 8 | ||
| 494 per 1000 | 514 per 1000 (464 to 563) | |||||
| Maternal blood loss of 500 mL or greater | Study population | RR 1.14 (0.07 to 17.63) | 180 (2 RCTs) | ⊕⊝⊝⊝ VERY LOW 9 10 | ||
| 11 per 1000 | 12 per 1000 (1 to 188) | |||||
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio | ||||||
| GRADE Working Group grades of evidence High certainty: We are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect | ||||||
1 Although many of the included studies have unclear risk of bias, the large trial which provided 80% of the data is low risk of bias. No downgrade.
2 Number of participants = 2680 and OIS > 11,000 (ref Tarnow‐Mordi 2017); number of events 171 less than the 300 calculated for confidence in findings; upper confidence interval close to the line of no difference. Downgrade 1.
3 25% of data comes from studies where the risk of bias is unclear or high, however, the large study which provides 70% of data are low risk of bias. No downgrade.
4 Number of participants 2083; number of events 86 (< 300 generally required); CI crosses line of no difference. Downgrade 2.
5 78% of data coming from studies of low risk of bias including the large study which is of low risk of bias. No downgrade.
6 Number of participants 2333; number of events 409. No downgrade.
7 Number of participants 1544 and number of events 26 (well below generally required 300). Downgrade 2.
8 98% of data comes from trials of low risk of selection bias, including 1 large well‐conducted trial. No downgrade.
9 Although Selection bias is low risk of bias, incomplete outcome data is high risk of bias. Downgrade 1.
10 Only 180 women and 2 events. Downgrade 2.