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. 2019 Sep 17;2019(9):CD003248. doi: 10.1002/14651858.CD003248.pub4

Comparison 1. DCC with immediate neonatal care after cord clamping vs ECC (subgroup analysis by gestation).

Outcome or subgroup title No. of studies No. of participants Statistical method Effect size
1 Death of baby (up to discharge) 20 2680 Risk Ratio (M‐H, Random, 95% CI) 0.73 [0.54, 0.98]
1.1 < 32‐34 weeks gestation 13 2108 Risk Ratio (M‐H, Random, 95% CI) 0.71 [0.52, 0.96]
1.2 > 32‐34 weeks gestation 3 237 Risk Ratio (M‐H, Random, 95% CI) 5.18 [0.25, 105.47]
1.3 Mixed gestation 4 335 Risk Ratio (M‐H, Random, 95% CI) 0.80 [0.09, 7.04]
2 Death or neurodevelopmental impairment in early years 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
2.1 < 32‐34 weeks gestation 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
2.2 > 32‐34 weeks gestation 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
2.3 Mixed gestation 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
3 Severe intraventricular haemorrhage (IVH grades 3, 4) 10 2058 Risk Ratio (M‐H, Random, 95% CI) 0.94 [0.63, 1.39]
3.1 < 32‐34 weeks gestation 9 1972 Risk Ratio (M‐H, Random, 95% CI) 0.95 [0.64, 1.42]
3.2 > 32‐34 weeks gestation 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
3.3 Mixed gestation 1 86 Risk Ratio (M‐H, Random, 95% CI) 0.58 [0.05, 6.11]
4 Intraventricular haemorrhage (IVH, all grades) 15 2333 Risk Ratio (M‐H, Random, 95% CI) 0.83 [0.70, 0.99]
4.1 < 32‐34 weeks gestation 11 1988 Risk Ratio (M‐H, Random, 95% CI) 0.76 [0.56, 1.02]
4.2 > 32‐34 weeks gestation 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
4.3 Mixed gestation 4 345 Risk Ratio (M‐H, Random, 95% CI) 0.66 [0.38, 1.16]
5 Periventricular leukomalacia (PVL) 4 1544 Risk Ratio (M‐H, Random, 95% CI) 0.58 [0.26, 1.30]
5.1 < 32‐34 weeks gestation 4 1544 Risk Ratio (M‐H, Random, 95% CI) 0.58 [0.26, 1.30]
5.2 > 32‐34 weeks gestation 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
5.3 Mixed gestation 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
6 Chronic lung disease (CLD) ‐ oxygen supplement at 36 weeks (corrected for gestation) 6 1644 Risk Ratio (M‐H, Random, 95% CI) 1.04 [0.94, 1.14]
6.1 < 32‐34 weeks gestation 6 1644 Risk Ratio (M‐H, Random, 95% CI) 1.04 [0.94, 1.14]
6.2 > 32‐34 weeks gestation 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
6.3 Mixed gestation 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
7 Maternal blood loss of 500 mL or greater 2 180 Risk Ratio (M‐H, Random, 95% CI) 1.14 [0.07, 17.63]
7.1 < 32‐34 weeks gestation 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
7.2 > 32‐34 weeks gestation 1 86 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
7.3 Mixed gestation 1 94 Risk Ratio (M‐H, Random, 95% CI) 1.14 [0.07, 17.63]
8 Intraventricular haemorrhage (IVH, grades 1 & 2) 9 1968 Risk Ratio (M‐H, Random, 95% CI) 0.72 [0.51, 1.02]
8.1 < 32‐34 weeks gestation 8 1882 Risk Ratio (M‐H, Random, 95% CI) 0.68 [0.45, 1.03]
8.2 > 32‐34 weeks gestation 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
8.3 Mixed gestation 1 86 Risk Ratio (M‐H, Random, 95% CI) 0.89 [0.37, 2.18]
9 Necrotising enterocolitis (NEC) confirmed by X‐ray or laparotomy) 11 2010 Risk Ratio (M‐H, Random, 95% CI) 0.91 [0.64, 1.28]
9.1 < 32‐34 weeks gestation 10 1916 Risk Ratio (M‐H, Random, 95% CI) 0.86 [0.60, 1.22]
9.2 > 32‐34 weeks gestation 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
9.3 Mixed gestation 1 94 Risk Ratio (M‐H, Random, 95% CI) 2.84 [0.58, 13.92]
10 Respiratory Distress Syndrome (RDS) 7 457 Risk Ratio (M‐H, Random, 95% CI) 1.09 [0.86, 1.38]
10.1 < 32‐34 weeks gestation 3 165 Risk Ratio (M‐H, Random, 95% CI) 1.21 [0.64, 2.27]
10.2 > 32‐34 weeks gestation 1 86 Risk Ratio (M‐H, Random, 95% CI) 0.79 [0.19, 3.30]
10.3 Mixed gestation 3 206 Risk Ratio (M‐H, Random, 95% CI) 1.32 [0.52, 3.36]
11 Respiratory support (ventilator or CPAP) 6 325 Risk Ratio (M‐H, Random, 95% CI) 0.95 [0.77, 1.16]
11.1 < 32‐34 weeks gestation 5 220 Risk Ratio (M‐H, Random, 95% CI) 0.96 [0.78, 1.18]
11.2 > 32‐34 weeks gestation 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
11.3 Mixed gestation 1 105 Risk Ratio (M‐H, Random, 95% CI) 0.57 [0.16, 2.09]
12 Duration of respiratory support (in days) 1 42 Mean Difference (IV, Random, 95% CI) ‐0.60 [‐3.04, 1.84]
12.1 < 32‐34 weeks gestation 1 42 Mean Difference (IV, Random, 95% CI) ‐0.60 [‐3.04, 1.84]
12.2 > 32‐34 weeks gestation 0 0 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
12.3 Mixed gestation 0 0 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
13 Surfactant treatment (for severe RDS) 3 145 Risk Ratio (M‐H, Random, 95% CI) 0.80 [0.50, 1.28]
13.1 < 32‐34 weeks gestation 3 145 Risk Ratio (M‐H, Random, 95% CI) 0.80 [0.50, 1.28]
13.2 > 32‐34 weeks gestation 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
13.3 Mixed gestation 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
14 Treatment for Patent Ductus Arteriosus (PDA) (medical and/or surgical) 10 2046 Risk Ratio (M‐H, Random, 95% CI) 1.12 [0.99, 1.26]
14.1 < 32‐34 weeks gestation 9 1952 Risk Ratio (M‐H, Random, 95% CI) 1.12 [0.99, 1.26]
14.2 > 32‐34 weeks gestation 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
14.3 Mixed gestation 1 94 Risk Ratio (M‐H, Random, 95% CI) 1.14 [0.24, 5.34]
15 Treatment for Retinopathy of Prematurity (RoP) 8 1827 Risk Ratio (M‐H, Random, 95% CI) 0.83 [0.62, 1.12]
15.1 < 32‐34 weeks gestation 8 1827 Risk Ratio (M‐H, Random, 95% CI) 0.83 [0.62, 1.12]
15.2 > 32‐34 weeks gestation 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
15.3 Mixed gestation 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
16 Hyperbilirubinemia (treated by phototherapy) 8 495 Risk Ratio (M‐H, Random, 95% CI) 1.05 [0.95, 1.16]
16.1 < 32‐34 weeks gestation 3 114 Risk Ratio (M‐H, Random, 95% CI) 1.01 [0.91, 1.11]
16.2 > 32‐34 weeks gestation 2 123 Risk Ratio (M‐H, Random, 95% CI) 0.73 [0.38, 1.41]
16.3 Mixed gestation 3 258 Risk Ratio (M‐H, Random, 95% CI) 1.17 [0.93, 1.47]
17 Inotropics for low blood pressure 5 250 Risk Ratio (M‐H, Random, 95% CI) 0.37 [0.17, 0.81]
17.1 < 32‐34 weeks gestation 5 250 Risk Ratio (M‐H, Random, 95% CI) 0.37 [0.17, 0.81]
17.2 > 32‐34 weeks gestation 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
17.3 Mixed gestation 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
18 Low Apgar as defined by trialists (generally < 8 at 5 mins) 4 1721 Risk Ratio (M‐H, Random, 95% CI) 1.07 [0.70, 1.63]
18.1 < 32‐34 weeks gestation 3 1637 Risk Ratio (M‐H, Random, 95% CI) 1.01 [0.62, 1.62]
18.2 > 32‐34 weeks gestation 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
18.3 Mixed gestation 1 84 Risk Ratio (M‐H, Random, 95% CI) 1.32 [0.53, 3.31]
19 Blood transfusion in infant 11 2280 Risk Ratio (M‐H, Random, 95% CI) 0.66 [0.50, 0.86]
19.1 < 32‐34 weeks gestation 8 1995 Risk Ratio (M‐H, Random, 95% CI) 0.64 [0.47, 0.87]
19.2 > 32‐34 weeks gestation 1 86 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
19.3 Mixed gestation 2 199 Risk Ratio (M‐H, Random, 95% CI) 0.67 [0.26, 1.74]
20 Volume of blood transfused (mL) 1 72 Mean Difference (IV, Random, 95% CI) ‐6.0 [‐26.11, 14.11]
20.1 < 32‐34 weeks gestation 1 72 Mean Difference (IV, Random, 95% CI) ‐6.0 [‐26.11, 14.11]
20.2 > 32‐34 weeks gestation 0 0 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
20.3 Mixed gestation 0 0 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
21 Late sepsis (after 3 days or as defined by trialists) 10 2017 Risk Ratio (M‐H, Random, 95% CI) 0.79 [0.56, 1.10]
21.1 < 32‐34 weeks gestation 9 1923 Risk Ratio (M‐H, Random, 95% CI) 0.76 [0.52, 1.11]
21.2 > 32‐34 weeks gestation 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
21.3 Mixed gestation 1 94 Risk Ratio (M‐H, Random, 95% CI) 0.87 [0.43, 1.79]
22 Hydrocephalus 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
22.1 < 32‐34 weeks gestation 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
22.2 > 32‐34 weeks gestation 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
22.3 Mixed gestation 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
23 Temperature < 36.0oC within 1 hour of birth 1 86 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
23.1 < 32‐34 weeks gestation 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
23.2 > 32‐34 weeks gestation 1 86 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
23.3 Mixed gestation 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
24 Hb within 1st 24 hour of birth (g/dL) 1 42 Mean Difference (IV, Random, 95% CI) 0.80 [‐0.02, 1.62]
24.1 < 32‐34 weeks gestation 1 42 Mean Difference (IV, Random, 95% CI) 0.80 [‐0.02, 1.62]
24.2 > 32‐34 weeks gestation 0 0 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
24.3 Mixed gestation 0 0 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
25 Mean arterial blood pressure in early hours after birth (mm Hg) 4 208 Mean Difference (IV, Random, 95% CI) 2.87 [1.09, 4.64]
25.1 < 32‐34 weeks gestation 4 208 Mean Difference (IV, Random, 95% CI) 2.87 [1.09, 4.64]
25.2 > 32‐34 weeks gestation 0 0 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
25.3 Mixed gestation 0 0 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
26 Length of infant stay in NICU 0 0 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
26.1 < 32‐34 weeks gestation 0 0 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
26.2 > 32‐34 weeks gestation 0 0 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
26.3 Mixed gestation 0 0 Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
27 Home oxygen 2 101 Risk Ratio (M‐H, Random, 95% CI) 0.47 [0.06, 3.72]
27.1 < 32‐34 weeks gestation 2 101 Risk Ratio (M‐H, Random, 95% CI) 0.47 [0.06, 3.72]
27.2 > 32‐34 weeks gestation 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
27.3 Mixed gestation 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
28 Neurodevelopmental impairment at age two to three years (Baileys 11 MDI < 70) 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
28.1 < 32‐34 weeks gestation 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
28.2 > 32‐34 weeks gestation 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
28.3 Mixed gestation 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
29 Severe visual impairment 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
29.1 < 32‐34 weeks gestation 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
29.2 > 32‐34 weeks gestation 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
29.3 Mixed gestation 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
30 Cerebral palsy (CP) 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
30.1 < 32‐34 weeks gestation 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
30.2 > 32‐34 weeks gestation 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
30.3 Mixed gestation 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
31 Manual removal of placenta (denominator = vaginal births) 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
31.1 < 32‐34 weeks gestation 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
31.2 > 32‐34 weeks gestation 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
31.3 Mixed gestation 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
32 Prolonged third stage (> 30 minutes) (denominator = vaginal births) 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
32.1 < 32‐34 weeks gestation 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
32.2 > 32‐34 weeks gestation 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
32.3 Mixed gestation 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
33 Blood transfusion for mother 1 1176 Risk Ratio (M‐H, Random, 95% CI) 0.67 [0.36, 1.24]
33.1 < 32‐34 weeks gestation 1 1176 Risk Ratio (M‐H, Random, 95% CI) 0.67 [0.36, 1.24]
33.2 > 32‐34 weeks gestation 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
33.3 Mixed gestation 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
34 Postpartum infection in mother 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
34.1 < 32‐34 weeks gestation 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
34.2 > 32‐34 weeks gestation 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
34.3 Mixed gestation 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
35 Rhesus isoimmunisation 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
35.1 < 32‐34 weeks gestation 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
35.2 > 32‐34 weeks gestation 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
35.3 Mixed gestation 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
36 Psychological well being in mother 0 0 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
36.1 < 32‐34 weeks gestation 0 0 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
36.2 > 32‐34 weeks gestation 0 0 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
36.3 Mixed gestation 0 0 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
37 Bonding 0 0 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
37.1 < 32‐34 weeks gestation 0 0 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
37.2 > 32‐34 weeks gestation 0 0 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
37.3 Mixed gestation 0 0 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
38 Breastfeeding initiation 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
38.1 < 32‐34 weeks gestation 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
38.2 > 32‐34 weeks gestation 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
38.3 Mixed gestation 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
39 Fully breastfed or mixed feeding at infant discharge 1 94 Risk Ratio (M‐H, Random, 95% CI) 1.11 [1.00, 1.23]
39.1 < 32‐34 weeks gestation 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
39.2 > 32‐34 weeks gestation 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
39.3 Mixed gestation 1 94 Risk Ratio (M‐H, Random, 95% CI) 1.11 [1.00, 1.23]
40 Maternal anxiety 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
40.1 < 32‐34 weeks gestation 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
40.2 > 32‐34 weeks gestation 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
40.3 Mixed gestation 0 0 Risk Ratio (M‐H, Random, 95% CI) 0.0 [0.0, 0.0]
41 Mothers' views 0 0 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
41.1 < 32‐34 weeks gestation 0 0 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
41.2 > 32‐34 weeks gestation 0 0 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]
41.3 Mixed gestation 0 0 Std. Mean Difference (IV, Random, 95% CI) 0.0 [0.0, 0.0]