Summary of findings 3. DCC with immediate neonatal care after cord clamping compared to UCM in babes born preterm.
| DCC with immediate neonatal care after cord clamping compared to UCM in babies born preterm | ||||||
| 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: umbilical cord milking (UCM). | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with UCM (subgroup analysis by gestation) | Risk with DCC with immediate neonatal care after cord clamping | |||||
| Death of baby (up to discharge) | Study population | RR 2.14 (0.93 to 4.93) | 322 (3 RCTs) | ⊕⊕⊝⊝ LOW 1 2 | ||
| 44 per 1000 | 94 per 1000 (41 to 216) | |||||
| Death or neurodevelopmental impairment at age 2 to 3 years | Study population | RR 1.67 (0.78 to 3.57) | 195 (2 RCTs) | ⊕⊝⊝⊝ VERY LOW 3 4 | ||
| 162 per 1000 | 270 per 1000 (126 to 577) | |||||
| Severe intraventricular haemorrhage (IVH grades 3, 4) | Study population | RR 2.63 (0.11 to 61.88) | 58 (1 RCT) | ⊕⊕⊝⊝ LOW 5 6 | ||
| 0 per 1000 | 0 per 1000 (0 to 0) | |||||
| Intraventricular haemorrhage (IVH, all grades) | Study population | RR 1.32 (0.55 to 3.17) | 125 (2 RCTs) | ⊕⊝⊝⊝ VERY LOW 7 8 | ||
| 129 per 1000 | 170 per 1000 (71 to 409) | |||||
| Periventricular leukomalacia (PVL) | Study population | not estimable | 58 (1 RCT) | ⊕⊕⊝⊝ LOW 9 10 | ||
| 0 per 1000 | 0 per 1000 (0 to 0) | |||||
| Chronic lung disease (CLD) ‐ oxygen supplement at 36 weeks (corrected for gestation) | Study population | RR 1.53 (0.43 to 5.48) | 125 (2 RCTs) | ⊕⊕⊝⊝ LOW 11 12 | ||
| 48 per 1000 | 74 per 1000 (21 to 265) | |||||
| Maternal blood loss of 500 mL or greater | Study population | ‐ | (0 studies) | ‐ | ||
| see comment | see comment | |||||
| *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 Risk of bias: two out of three studies were low risk of bias for sequence generation, allocation concealment and incomplete outcome data and provided over 90% of data. No downgrade.
2 Imprecision: small number of participants (N = 322); very few events (n = 24) and wide 95% CI crossing line of no difference. Downgrade 2.
3 One study providing over 70% of data was high risk of attrition bias and selective outcome reporting bias. Downgrade 1.
4 Wide CI crossing line of no difference, small number of participants (N = 195) and few events (n = 41). Downgrade 2.
5 One small study ‐ low risk of bias. No downgrade.
6 Small sample size (N = 58), only 1 event and wide 95% CI crossing line of no difference. Downgrade 2.
7 One study providing over 50% of data was unclear for selection bias. Downgrade 1.
8 Small sample size (N = 125), few events (n = 19) and wide 95% CI crossing line of no difference. Downgrade 2.
9 Risk of bias: low for sequence generation, allocation concealment and incomplete outcome data. No downgrade.
10 Imprecision: small sample size (N = 58) and no events. Downgrade 2.
11 One study provided 82% of the data were assessed as low risk of bias. No downgrade.
12 Small sample size (N = 125), very few events (n = 9) and wide 95% CI crossing line of no difference. Downgrade 2.