Short and long-term outcomes of placental transfusion in very low birth weight infants: a meta analysis / 中华围产医学杂志

ABSTRACT

Objective To investigate the risks and benefits of interventions promoting placental transfusion (PT) at delivery [delayed cord clamping (DCC) or umbilical cord milking (UCM)] compared with early cord clamping (ECC) on outcomes among very low birth weight infants (VLBWI).Methods A systematic search was conducted of PubMed, EMBASE, ClinicalTrials.gov, China Academic Journal Network Publishing Database and Wanfang Medical Databases (January 1965 to July 2014) for randomized controlled trial (RCT) articles relating to PT strategies (DCC and UCM) in VLBWI.The Cochrane Handbook 5.1.0 was used to evaluate the methodological quality and RevMan 5.3 software from Cochrane Collaboration was used for metaanalysis.The fixed effect or random effect model was adopted according to the result of heterogeneity, Results We identified 14 eligible studies describing a total of 659 neonates with an average birth weight ＜ 1 500 g.There were eight studies for DCC and six studies for UCM.Compared with the control, benefits of greater PT decreased any grade intraventricular hemorrhage (IVH) (nine studies, OR=0.49, 95％CI 0.32-0.77, P ＜ 0.01), increased the blood pressure at four hours of life (eight studies, MD=4.42, 95％CI 3.85-4.98, P ＜ 0.01), and also showed higher initial hemoglobin (Hb) level (six studies, MD=3.52, 95％CI 1.67-5.37, P ＜ 0.01) and lower incidence of sepsis during the hospital stay (five studies, OR=0.46, 95％CI 0.26-0.83, P=0.01).No differences were observed between the groups about the fllowing indicators (all P ＞ 0.05) 5-minute Apgar scores (MD=0.01,95％CI-0.21-0.22), admission temperature (MD=0.13, 95％CI-0.15 to 0.41), peak serum bilirubin levels (MD=0.59, 95％CI-0.13 to 1.31), initial reported hematocrit (MD=3.48, 95％CI-0.46 to 7.43), mortality before discharge (OR=0.63, 95％CI0.31-1.25), Bell's stage 2 or greater necrotizing enterocolitis (OR=0.62 ,95％CI 0.29-1.33), rates of transfusion due to anemia (OR=0.63, 95％CI 0.35-1.15) and oxygen therapy at 36 weeks of corrected age (OR=0.79, 95％CI 0.46-1.34).Conclusions It is suggested that enhanced PT (both DCC and UCM) at birth is safe and provide better neonatal outcomes than ECC for those VLBWI, most notably reduces the overall IVH occurrence and lower the incidence of sepsis.The optimal umbilical cord clamping practice and UCM among VLBWI infants remains uncertain and long-term neurodevelopmental outcomes are warranted.