Summary of findings 2. DCC with immediate neonatal care with cord intact compared to ECC in babies born preterm.
| DCC with immediate neonatal care with cord intact compared to ECC in babies born preterm | ||||||
| Patient or population: babies born preterm, and their mothers Setting: hospital births in UK Intervention: delayed cord clamping (DCC) with immediate neonatal care with cord intact 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 with cord intact | |||||
| Death of baby (up to discharge) | Study population | RR 0.47 (0.20 to 1.11) | 270 (1 RCT) | ⊕⊕⊝⊝ LOW 1 | ||
| 111 per 1000 | 52 per 1000 (22 to 123) | |||||
| Death or neurodevelopmental impairment at age 2 to 3 years | Study population | RR 0.61 (0.39 to 0.96) | 218 (1 RCT) | ⊕⊕⊝⊝ LOW 2 | ||
| 340 per 1000 | 207 per 1000 (133 to 326) | |||||
| Severe intraventricular haemorrhage (IVH grades 3, 4) | Study population | RR 0.84 (0.29 to 2.45) | 266 (1 RCT) | ⊕⊕⊝⊝ LOW 3 | ||
| 53 per 1000 | 45 per 1000 (15 to 130) | |||||
| Intraventricular haemorrhage (IVH, all grades) | Study population | RR 0.90 (0.64 to 1.26) | 266 (1 RCT) | ⊕⊕⊝⊝ LOW 4 | ||
| 356 per 1000 | 320 per 1000 (228 to 449) | |||||
| Periventricular leukomalacia (PVL) | Study population | RR 0.86 (0.32 to 2.31) | 266 (1 RCT) | ⊕⊕⊝⊝ LOW 5 | ||
| 61 per 1000 | 52 per 1000 (19 to 140) | |||||
| Chronic lung disease (CLD) ‐ oxygen supplement at 36 weeks (corrected for gestation) | Study population | RR 0.95 (0.66 to 1.37) | 249 (1 RCT) | ⊕⊕⊝⊝ LOW 6 | ||
| 325 per 1000 | 309 per 1000 (215 to 445) | |||||
| Maternal blood loss of 500 mL or greater | Study population | RR 0.94 (0.72 to 1.22) | 254 (1 RCT) | ⊕⊕⊝⊝ LOW 7 8 | ||
| 476 per 1000 | 447 per 1000 (343 to 580) | |||||
| *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 Only one small study (N = 270); wide CI crossing line of no effect and very few events (n = 22). Downgrade 2.
2 Only one small study (N = 218); wide CI crossing line of no effect and very few events (n = 59). Downgrade 2.
3 Only one small study (N = 266); wide CI crossing line of no effect and very few events (n = 13). Downgrade 2.
4 Only one small study (N = 266); wide CI crossing line of no effect and few events (n = 90). Downgrade 2.
5 Only one small study (N = 266); wide CI crossing line of no effect and very few events (n = 15). Downgrade 2.
6 Only one small study (N = 249); wide CI crossing line of no effect and few events (n = 79). Downgrade 2.
7 High risk of bias through not being able to blind clinicians or women and this outcome. Downgrade 1.
8 Only one small study (N = 254); wide CI crossing line of no effect and few events (n = 117). Downgrade 1.