Comparison 3. DCC with immediate neonatal care with cord intact 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)	1	270	Risk Ratio (M‐H, Random, 95% CI)	0.47 [0.20, 1.11]
1.1 < 32‐34 weeks gestation	1	270	Risk Ratio (M‐H, Random, 95% CI)	0.47 [0.20, 1.11]
1.2 > 32‐34 weeks gestation	0	0	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
1.3 Mixed gestation	0	0	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
2 Death or neurodevelopmental impairment at age two to three years	1	218	Risk Ratio (M‐H, Random, 95% CI)	0.61 [0.39, 0.96]
2.1 < 32‐34 weeks gestation	1	218	Risk Ratio (M‐H, Random, 95% CI)	0.61 [0.39, 0.96]
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)	1	266	Risk Ratio (M‐H, Random, 95% CI)	0.84 [0.29, 2.45]
3.1 < 32‐34 weeks gestation	1	266	Risk Ratio (M‐H, Random, 95% CI)	0.84 [0.29, 2.45]
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	0	0	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
4 Intraventricular haemorrhage (IVH, all grades)	1	266	Risk Ratio (M‐H, Random, 95% CI)	0.90 [0.64, 1.26]
4.1 < 32‐34 weeks gestation	1	266	Risk Ratio (M‐H, Random, 95% CI)	0.90 [0.64, 1.26]
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	0	0	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
5 Periventricular leukomalacia (PVL)	1	266	Risk Ratio (M‐H, Random, 95% CI)	0.86 [0.32, 2.31]
5.1 < 32‐34 weeks gestation	1	266	Risk Ratio (M‐H, Random, 95% CI)	0.86 [0.32, 2.31]
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)	1	249	Risk Ratio (M‐H, Random, 95% CI)	0.95 [0.66, 1.37]
6.1 < 32‐34 weeks gestation	1	249	Risk Ratio (M‐H, Random, 95% CI)	0.95 [0.66, 1.37]
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	1	254	Risk Ratio (M‐H, Random, 95% CI)	0.94 [0.72, 1.22]
7.1 < 32‐34 weeks gestation	1	254	Risk Ratio (M‐H, Random, 95% CI)	0.94 [0.72, 1.22]
7.2 > 32‐34 weeks gestation	0	0	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
7.3 Mixed gestation	0	0	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
8 Intraventricular haemorrhage (IVH, grades 1 & 2)	1	266	Risk Ratio (M‐H, Random, 95% CI)	0.91 [0.63, 1.33]
8.1 < 32‐34 weeks gestation	1	266	Risk Ratio (M‐H, Random, 95% CI)	0.91 [0.63, 1.33]
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	0	0	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
9 Necrotising enterocolitis (NEC) confirmed by X‐ray or laparotomy)	1	266	Risk Ratio (M‐H, Random, 95% CI)	1.58 [0.53, 4.69]
9.1 < 32‐34 weeks gestation	1	266	Risk Ratio (M‐H, Random, 95% CI)	1.58 [0.53, 4.69]
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	0	0	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
10 Respiratory Distress Syndrome (RDS)	0	0	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
10.1 < 32‐34 weeks gestation	0	0	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
10.2 > 32‐34 weeks gestation	0	0	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
10.3 Mixed gestation	0	0	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
11 Respiratory support (ventilator or CPAP)	1	266	Risk Ratio (M‐H, Random, 95% CI)	0.96 [0.84, 1.09]
11.1 < 32‐34 weeks gestation	1	266	Risk Ratio (M‐H, Random, 95% CI)	0.96 [0.84, 1.09]
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	0	0	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
12 Duration of respiratory support	0	0	Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
12.1 < 32‐34 weeks gestation	0	0	Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
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)	0	0	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
13.1 < 32‐34 weeks gestation	0	0	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
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)	1	266	Risk Ratio (M‐H, Random, 95% CI)	0.99 [0.56, 1.74]
14.1 < 32‐34 weeks gestation	1	266	Risk Ratio (M‐H, Random, 95% CI)	0.99 [0.56, 1.74]
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	0	0	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
15 Treatment for Retinopathy of Prematurity (RoP)	1	249	Risk Ratio (M‐H, Random, 95% CI)	0.93 [0.28, 3.13]
15.1 < 32‐34 weeks gestation	1	249	Risk Ratio (M‐H, Random, 95% CI)	0.93 [0.28, 3.13]
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)	1	266	Risk Ratio (M‐H, Random, 95% CI)	1.01 [0.94, 1.09]
16.1 < 32‐34 weeks gestation	1	266	Risk Ratio (M‐H, Random, 95% CI)	1.01 [0.94, 1.09]
16.2 > 32‐34 weeks gestation	0	0	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
16.3 Mixed gestation	0	0	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
17 Inotropics for low blood pressure	0	0	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
17.1 < 32‐34 weeks gestation	0	0	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
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)	0	0	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
18.1 < 32‐34 weeks gestation	0	0	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
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	0	0	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
19 Blood transfusion in infant	1	266	Risk Ratio (M‐H, Random, 95% CI)	0.91 [0.71, 1.17]
19.1 < 32‐34 weeks gestation	1	266	Risk Ratio (M‐H, Random, 95% CI)	0.91 [0.71, 1.17]
19.2 > 32‐34 weeks gestation	0	0	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
19.3 Mixed gestation	0	0	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
20 Volume of blood transfused (mL)	0	0	Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
20.1 < 32‐34 weeks gestation	0	0	Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
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)	1	266	Risk Ratio (M‐H, Random, 95% CI)	0.89 [0.72, 1.09]
21.1 < 32‐34 weeks gestation	1	266	Risk Ratio (M‐H, Random, 95% CI)	0.89 [0.72, 1.09]
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	0	0	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
22 Hydrocephalus	1	266	Risk Ratio (M‐H, Random, 95% CI)	0.99 [0.14, 6.89]
22.1 < 32‐34 weeks gestation	1	266	Risk Ratio (M‐H, Random, 95% CI)	0.99 [0.14, 6.89]
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	266	Risk Ratio (M‐H, Random, 95% CI)	1.20 [0.61, 2.33]
23.1 < 32‐34 weeks gestation	1	266	Risk Ratio (M‐H, Random, 95% CI)	1.20 [0.61, 2.33]
23.2 > 32‐34 weeks gestation	0	0	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)	0	0	Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
24.1 < 32‐34 weeks gestation	0	0	Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
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 (subgrouped by time after birth)	0	0	Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
25.1 < 32‐34 weeks gestation	0	0	Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
25.2 Mixed gestation	0	0	Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
25.3 > 32‐34 weeks 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	0	0	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
27.1 < 32‐34 weeks gestation	0	0	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
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	1	218	Risk Ratio (M‐H, Random, 95% CI)	0.75 [0.41, 1.39]
28.1 < 32‐34 weeks gestation	1	218	Risk Ratio (M‐H, Random, 95% CI)	0.75 [0.41, 1.39]
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)	1	105	Risk Ratio (M‐H, Random, 95% CI)	0.99 [0.32, 3.04]
31.1 < 32‐34 weeks gestation	1	105	Risk Ratio (M‐H, Random, 95% CI)	0.99 [0.32, 3.04]
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)	1	105	Risk Ratio (M‐H, Random, 95% CI)	0.79 [0.24, 2.64]
32.1 < 32‐34 weeks gestation	1	105	Risk Ratio (M‐H, Random, 95% CI)	0.79 [0.24, 2.64]
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	254	Risk Ratio (M‐H, Random, 95% CI)	1.59 [0.39, 6.51]
33.1 < 32‐34 weeks gestation	1	254	Risk Ratio (M‐H, Random, 95% CI)	1.59 [0.39, 6.51]
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	1	254	Risk Ratio (M‐H, Random, 95% CI)	1.12 [0.73, 1.72]
34.1 < 32‐34 weeks gestation	1	254	Risk Ratio (M‐H, Random, 95% CI)	1.12 [0.73, 1.72]
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	248	Risk Ratio (M‐H, Random, 95% CI)	0.98 [0.79, 1.22]
39.1 < 32‐34 weeks gestation	1	248	Risk Ratio (M‐H, Random, 95% CI)	0.98 [0.79, 1.22]
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	0	0	Risk Ratio (M‐H, Random, 95% CI)	0.0 [0.0, 0.0]
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]