Does the umbilical cord management strategy used in preterm infants impact mortality?

March 18, 2021
Miranda Hester

Ms. Hester is Content Specialist with Contemporary OB/GYN and Contemporary Pediatrics.

A meta-analysis examines whether the umbilical cord management strategy used in preterm infants has an effect on mortality and morbidity.

There are a variety of umbilical cord management strategies that are used with infants. An investigation in JAMA Pediatrics examines whether a particular strategy was linked to a reduction in mortality and morbidity in infants who are preterm.1

The investigators used PubMed, Embase, CINAHL, and Cochrane CENTRAL databases to find randomized clinical trials that compared different umbilical cord management strategies used with preterm infants. The strategies examined were immediate umbilical cord clamping, delayed umbilical cord clamping, umbilical cord milking, and umbilical cord milking as well as delayed umbilical cord clamping.

A total of 56 studies were included in the meta-analysis and 6852 preterm infants were enrolled in those studies. When compared with immediate umbilical cord clamping, delayed umbilical cord clamping was linked to lower odds of mortality mortality (22 trials, 3083 participants; 7.6% vs 5.0%; odds ratio [OR], 0.64; 95% credible interval [CrI], 0.39-0.99), intraventricular hemorrhage (25 trials, 3316 participants; 17.8% vs 15.4%; OR, 0.73; 95% CrI, 0.54-0.97), and the need for a packed red blood cell transfusion (18 trials, 2904 participants; 46.9% vs 38.3%; OR, 0.48; 95% CrI, 0.32-0.66). Umbilical cord milking was also linked to lower odds of a needed packed red blood cell transfusion (9 trials, 688 participants; 47.3% vs 32.3%; OR, 0.36; 95% CrI, 0.23-0.53) and intraventricular hemorrhage (10 trials, 645 participants; 22.5% vs 16.2%; OR, 0.58; 95% CrI, 0.38-0.84), when compared to immediate cord clamping. No significant difference was noted between delayed cord clamping and umbilical cord clamping for any outcome.

The investigators concluded that using delayed cord clamping had lower odds of mortality in preterm infants, when compared to immediate clamping. Additionally, both delayed cord clamping and umbilical cord milking were linked to reduction in morbidities, such as intraventricular hemorrhage. The investigators also urged further study comparing delayed cord clamping and umbilical cord milking.

Reference

1. Jasani B, Torgalkar R, Ye X, Syed S, Shah P. Association of umbilical cord management strategies with outcomes of preterm infants. JAMA Pediatr. March 8, 2021. Epub ahead of print. doi:10.1001/jamapediatrics.2021.0102