ABSTRACT
OBJECTIVES@#To study the influence of umbilical cord milking versus delayed cord clamping on the early prognosis of preterm infants with a gestational age of <34 weeks.@*METHODS@#PubMed, Web of Science, Embase, the Cochrane Library, CINAHL, China National Knowledge Infrastructure, Wanfang Data, Weipu Database, and SinoMed were searched for randomized controlled trials on umbilical cord milking versus delayed cord clamping in preterm infants with a gestational age of <34 weeks published up to November 2021. According to the inclusion and exclusion criteria, two researchers independently performed literature screening, quality evaluation, and data extraction. Review Manger 5.4 was used for Meta analysis.@*RESULTS@#A total of 11 articles were included in the analysis, with 1 621 preterm infants in total, among whom there were 809 infants in the umbilical cord milking group and 812 in the delayed cord clamping group. The Meta analysis showed that compared with delayed cord clamping, umbilical cord milking increased the mean blood pressure after birth (weighted mean difference=3.61, 95%CI: 0.73-6.50, P=0.01), but it also increased the incidence rate of severe intraventricular hemorrhage (RR=1.83, 95%CI: 1.08-3.09, P=0.02). There were no significant differences between the two groups in hemoglobin, hematocrit, blood transfusion rate, proportion of infants undergoing phototherapy, bilirubin peak, and incidence rates of complications such as periventricular leukomalacia and necrotizing enterocolitis (P>0.05).@*CONCLUSIONS@#Compared with delayed cord clamping, umbilical cord milking may increase the risk of severe intraventricular hemorrhage in preterm infants with a gestational age of <34 weeks; however, more high-quality large-sample randomized controlled trials are needed for further confirmation.
Subject(s)
Female , Humans , Infant , Infant, Newborn , Pregnancy , Cerebral Hemorrhage , Constriction , Gestational Age , Infant, Premature , Prognosis , Umbilical Cord/physiology , Umbilical Cord ClampingABSTRACT
Objective To investigate the value of A2DS2 score in predicting stroke-associated pneumonia (SAP) in patients with anterior and posterior circulation ischemic stroke. Methods The clinical data of patients with acute ischemic stroke admitted to the Department of Neurology, Heze Municipal Hospital from June 2011 to March 2016 were analyzed retrospectively. The independent risk factors for SAP were determined by binary multivariate logistic regression analysis. The value of A2DS2 score in predicting SAP in patients with anterior and posterior circulation ischemic stroke was evaluated by the receiver operator characteristic (ROC) curve. Results A total of 530 patients with acute ischemic stroke were enrolled, 90 of them (16. 98％) had SAP. There was no significant difference in SAP incidence between the patients with anterior circulation stroke (n = 430) and posterior circulation stroke (n = 100)(17. 2％ vs. 16. 0％; χ2 = 0. 084, P = 0. 772). Binary multivariate logistic regression analysis showed that the A2DS2 score was an independent risk factor for SAP in patients with ischemic stroke (odds ratio [OR] 1. 644, 95％ confidence interval [CI] 1. 097-2. 426), anterior circulation stroke (OR 1. 593, 95％ CI 1. 086- 2. 387), and posterior circulation stroke (OR 1. 463, 95％ CI 1. 064-2. 174). The ROC curve showed that the area under the curve of the A2DS2 score predicting SAP in patients with ischemic stroke, anterior circulation and posterior circulation stroke were 0. 826 (95％ CI 0. 792-0. 869), 0. 821 (95％ CI 0. 783-0. 858), and 0. 832 (95％ CI 0. 781-0. 923), respectively. The best cut-off value was 5. There was no significant difference in the area under SAP curve of the A2DS2 score for predicting SAP between patients with acute anterior circulation and posterior circulation ischemic stroke (Z = 0. 259, P = 0. 394). Conclusion A2DS2 score could predict SAP in patients with anterior circulation and posterior circulation stroke without difference, both of the cut-off value was 5.