Elimian 2014.

Methods	Randomised controlled trial
Participants	Inclusion criteria Singleton pregnancies, between 24 weeks 0 days and 34 weeks 0 days of gestation who were deemed to be at risk of giving birth prematurely Singleton pregnancies N = 200 babies Exclusion criteria Pregnant women carrying fetuses with known major fetal structural or chromosomal abnormalities, multiple gestations, diabetes, IUGR, or non reassuring fetal heart tracings.
Interventions	Intervention: UCM 3‐4 passes of milking of the umbilical cord toward the neonate Cord clamped after 30 secs Oxytocin after placental delivery Care also included warming mattress, bulb suction and stimulation as appropriate N = 99 babies Comparator: ECC Cord clamped within 5 secs Oxytocin after placental delivery N = 101 babies Additional information Gestational subgroup: < 32‐34 weeks' gestation Resuscitation with cord intact: not available Access to NICU: yes Length of delay: UCM + delay 30 secs Baby placed: no information so assume level with uterus or placenta Uterotonic: after cord clamping (actually after birth) UCM: 3‐4 times with DCC Comparison 7 UCM vs ECC (subgroup by gestation) Subgroup 1: < 32‐34 weeks' gestation Comparison 8 UCM vs ECC (subgroup by type of intervention) Subgroup 1: cord intact during UCM
Outcomes	Primary Need for blood transfusion as determined by neonatologists who in general initiated red blood cell transfusion when the Hb was below 10 g/dL (Hct 30%) or anaemia was symptomatic. Secondary Initial Hb and Hct (Hct and Hb were determined on venous blood drawn within the first 4 hrs of life) IVH. Each preterm neonate had transfontanellar cranial ultrasound scans within the first 3 days of life and on day 7. Neurosonograms were evaluated by skilled radiologists not aware of the assigned group with regard to cord clamping. IVH was graded as described by Papile et al.8 Periventricular leukomalacia was diagnosed by the presence of persistent echogenicity or echolucent areas in the periventricular region on sagittal and coronal views Requirement for resuscitation Apgar scores at 5 mins and 10 mins Hypothermia during first hour of life Death RDS (assessed by clinical signs, oxygen requirement, respiratory support, chest radiograph) during first 36 hrs of life. Use of exogenous surfactant. Days of ventilation. Days of oxygen dependency. Oxygen dependency at 28 days after birth. Oxygen dependency at equivalent of 36 completed weeks of gestational age. Chronic lung disease (Northway stage 2, 3, or 4). Number and volume of blood transfusions Volume (colloid, sodium chloride 0.9%, blood transfusion) administration for hypotension during the first 24 hrs of life, inotropic support for hypotension during the first 24 hrs of life, and Treatment for PDA Rate of anaemia of prematurity (defined as Hb less than 10 g/dL or Hct less than 30%) Treatment for hyperbilirubinaemia with phototherapy Treatment for hyperbilirubinaemia with blood exchange transfusion IVH grades 3 and 4 Periventricular leukomalacia NEC Maternal outcome evaluated included postpartum haemorrhage, retained placenta, uterine inversion, and maternal mortality
Notes	Setting: Teaching and Research Center of Konya, University of Baskent, Turkey. Dates: September 2008 – April 2009 Declaration of interest: the authors reported no potential conflicts of interest. Trial funding source: sponsor was University of Oklahoma Further information: Dr A Elimian kindly provided additional information (24.02.2016) regarding this study. In particular, the babies in the intervention group received UCM before the cord was clamped and cut at after 30 secs. We have chosen to regard the intervention, therefore, as UCM.
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Quote: “Allocation sequence was generated by a computer"
Allocation concealment (selection bias)	Low risk	Quote: “The allocation sequence was concealed by using sequentially numbered, opaque, sealed envelopes kept in a central location on labor and delivery.”
Blinding of participants and personnel (performance bias) All outcomes	High risk	Open label
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	The only blinding was the neuroradiologists who interpreted the cranial ultrasound scans so IVH and PVL are low risk of bias.
Incomplete outcome data (attrition bias) All outcomes	Low risk	No losses after randomisation.
Selective reporting (reporting bias)	Unclear risk	We checked the publication against the trial registration form, but the form did not list the outcomes to be measured. Requirement for resuscitation was the only unreported outcome. Some outcomes reported in categorical way when continuous data were suggested in methods and could easily have been given.
Other bias	Low risk	Used ITT. No difference at baseline for maternal age, height and weight, ethnicity, and selected maternal outcome variables. No other biases apparent.