Table 7.
Meta-Analysis for Comparison 1: Later (Delayed) Cord Clamping (≥30 Seconds) Compared With Early Cord Clamping (<30 Seconds) for Preterm Infants
| Outcome | Included studies | Total, n | Certainty of evidence | RR (95% CI); I2 | Absolute difference (95% CI) or mean difference (95% CI); I2 |
|---|---|---|---|---|---|
| Survival to discharge | Armanian et al,189 2017 Backes et al,190 2016 Baenziger et al,191 2017 Das et al,192 2018 Duley et al,195 2018 Finn et al,196 2019 Hofmeyr et al,198 1988 Hofmeyer et al,199 1993 Kazemi et al,200 2017 Kinmond et al,201 1993 Kugelman et al,202 2007 McDonnell and Henderson-Smart,205 1997 Mercer et al,203 2003 Mercer et al,204 2006 Oh et al,206 2011 Rabe et al,208 2000 Ruangkit et al,209 2019 Tarnow-Modri et al,210 2017 |
2988 | Moderate | 1.02 (1.00–1.04); 0% | 18/1000 more infants (0–36 more per 1000) survived when later cord clamping was intended than when early cord clamping was intended |
| Severe IVH | Armanian et al,189 2017 Backes et al,190 2016 Das et al,192 2018 Dong et al,194 2016 Duley et al,195 2018 Finn et al,196 2019 Kazemi et al,200 2017 Kugelman et al,202 2007 Mercer et al,203 2003 Mercer et al,204 2006 Rabe et al,208 2000 Rana et al,207 2018 Ruangkit et al,209 2019 Tarnow-Modri et al,210 2017 |
2972 | Low | 0.98 (0.67–1.42); 0% | 1/1000 fewer infants (10 fewer–10 more per 1000) developed severe IVH when later cord clamping was intended than when early cord clamping was intended |
| Hb concentration within 24 h after birth | Baenziger et al,191 2007 Dong et al,194 2016 Finn et al,196 2019 Gokmen et al,197 2011 |
196 | Moderate | MD, 1.24 g/dL (0.01–2.47); 79% | |
| Hct within 24 h after birth | Armanian et al,189 2017 Backes et al,190 2016 Baenziger et al,191 2007 Das et al,192 2018 Dipak et al,193 2017 Gokmen et al,197 2011 Kinmond et al,201 1993 Kugelman et al,202 2007 McDonnell and Henderson-Smart,205 1997 Mercer et al,203 2003 Mercer et al,204 2006 Oh et al,206 2011 Rabe et al,208 2000 Ruangkit et al,209 2019 |
1022 | High | MD, 2.63% (1.85–3.42); 5% | |
| Hct within 7 d after birth | Tarnow-Mordi et al,210 2017 | 1550 | High | MD, 2.70% (1.88–3.52)* | |
| Inotropic support for hypotension within 24 h after birth | Dong et al,194 2016 Gokmen et al,197 2011 McDonnell and Henderson-Smart,205 1997 Oh et al,206 2011 Rabe et al,208 2000 Ruangkit et al,209 2019 |
351 | Moderate | 0.36 (0.17–0.75); 0% | 91/1000 fewer infants (30–143 fewer per 1000) received inotropic support in 24 h after birth when later cord clamping was intended |
| Lowest MAP in the first 12 h after birth | Baenziger et al,191 2007 Finn et al,196 2019 Gokmen et al,197 2011 Kugelman et al,202 2007 Mercer et al,203 2003 Mercer et al,204 2006 Ruangkit et al,209 2019 |
374 | Low | MD, 1.79 mm Hg (0.53–3.05); 0% | |
| No. of infants receiving any blood transfusions | Armanian et al,189 2017 Das et al,192 2018 Dipak et al,193 2017 Dong et al,194 2016 Duley et al,195 2018 Finn et al,196 2019 Kugelman et al,202 2007 Mercer, et al,204 2006 Rabe et al,208 2000 Rana et al,207 2018 Ruangkit et al,209 2019 Tarnow-Mordi et al,210 2017 |
2910 | Low | 0.83 (0.77–0.90); 36% | 71/1000 fewer infants (40–111 fewer per 1000) received any blood transfusions when later cord clamping was intended than when early cord clamping was intended |
| Maternal PPH (≥500 mL) | Duley et al,195 2018 Ruangkit et al,209 2019 Tarnow-Mordi et al,210 2017 |
1477 | Low | 0.93 (0.54–1.62); 52%; random effects | 7/1000 fewer mothers (8 fewer–12 more per 1000) developed a PPH (≥500 mL) when later cord clamping was intended than when early cord clamping was intended |
Hb indicates hemoglobin; Hct, hematocrit; IVH, intraventricular hemorrhage; MAP, mean arterial blood pressure; MD, mean difference; PPH, postpartum hemorrhage; and RR, risk ratio.
*
There was only 1 trial, so no I2 was available.