Provision of respiratory support compared to no respiratory support before cord clamping for preterm infants

Michael P Meyer; Elizabeth Nevill; Maisie M Wong

doi:10.1002/14651858.CD012491.pub2

Asistencia respiratoria comparada con ninguna asistencia respiratoria antes del pinzamiento del cordón umbilical en recién nacidos prematuros

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Katheria A, Poeltler D, Durham J, Steen J, Rich W, Arnell K, et al. Neonatal resuscitation with an intact cord: a randomized clinical trial. Journal of Pediatrics 2016;178:75‐80.e3. [DOI: 10.1016/j.jpeds.2016.07.053; NCT02231411; PUBMED: 27574999]

NCT02231411. Neonatal resuscitation with intact cord (NRIC). clinicaltrials.gov/ct2/show/NCT02231411 Date first received: 4 September 2014.

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Aladangady N, McHugh S, Aitchison TC, Wardrop CA, Holland BM. Infants' blood volume in a controlled trial of placental transfusion at preterm delivery. Pediatrics 2006;117(1):93‐8. [DOI: 10.1542/peds.2004‐1773; PUBMED: 16396865]

Duley L, Dorling J, Pushpa‐Rajah A, Oddie SJ, Yoxall CW, Schoonakker B, et al. Cord Pilot Trial Collaborative Group. Randomized trial of cord clamping and initial stabilisation at very preterm birth. Archives of Disease in Childhood. Fetal and Neonatal Edition 2018;103(1):F6‐14. [PUBMED: 28923985]

Phillipos W, Solevåg AL, Aziz K, van Os S, Pichler G, O'Reilly M, et al. Oxygen saturation and heart rate ranges in very preterm infants requiring respiratory support at birth. Journal of Pediatrics 2017;182:41‐6.e2. [DOI: 10.1016/j.jpeds.2016.11.014; PUBMED: 27939259]

Winter J, Kattwinkel J, Chisholm C, Blackman A, Wilson S, Fairchild K. Ventilation of preterm Infants during delayed cord clamping (VentFirst): a pilot study of feasibility and safety. American Journal of Perinatology 2017;34(2):111‐6. [DOI: 10.1055/s‐0036‐1584521; PUBMED: 27305177]

Referencias de los estudios en curso

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Provision of Breathing Support during Delayed Cord Clamping in Preterm Infants.. Ongoing studyFebruary 2016..

Stabilisation of Preterm Infants with Intact Umbilical Cord, Aeration, Breathing, then Clamping: a Feasibility Study.. Ongoing studyRegistered September 2016..

NCT02742454. VentFirst: a multicenter RCT of assisted ventilation during delayed cord clamping for extremely preterm infants. clinicaltrials.gov/ct2/show/NCT02742454 Date first received: 19 April 2016.

Referencias adicionales

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Committee on Obstetric Practice, American College of Obstetricians and Gynecologists. Committee opinion No.543: timing of umbilical cord clamping after birth. Obstetrics and Gynecology 2012;120(6):1522‐6. [DOI: 10.1097/01.AOG.0000423817.47165.48; PUBMED: 23168790]

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Meyer MP, Nevill E, Wong M. Provision of respiratory support compared to no respiratory support before cord clamping for preterm infants. Cochrane Database of Systematic Reviews 2017, Issue 1. [DOI: 10.1002/14651858.CD012491]

Characteristics of studies

Characteristics of included studies [ordered by study ID]

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Katheria 2016

Methods	Single‐centre randomized controlled trial stratified by gestational age and mode of delivery (caesarean section (83%) or vaginal birth (17%)). Sample size of 150 infants estimated to detect a 15% difference in peak haematocrit. A waiver of informed consent was obtained for women presenting in active labour.
Participants	Preterm infants 23 to 31 weeks 6 days' gestation delivered at Sharp Mary Birch Hospital in San Diego.
Interventions	Intervention group: V‐DCC: 75 infants received 60 seconds of CPAP or PPV with room air provided by facemask with a T‐piece resuscitator. Apnoeic infants were briefly stimulated and given PPV followed by CPAP when breathing was established. A colorimetric carbon dioxide detector used to assess adequacy of ventilation. Control group: DCC: 75 infants received 60 seconds of DCC. They were dried and, if apnoeic, received gentle stimulation.
Outcomes	Primary outcome: maximum haematocrit in first 24 hours presented as mean and SD depending on the method of birthing (vaginal or caesarean). Authors provided unpublished data that allowed group comparisons between V‐DCC and DCC to be made. Inhospital mortality rate (1 of the primary outcomes of the current review) was likewise presented according to mode of birth. Condition at birth; measures of cardiovascular status; haematological and respiratory outcomes; and neonatal outcomes including intraventricular haemorrhage, blood transfusion, and duration of phototherapy were also reported by mode of birth. Event rates for categorical variables (e.g. mortality for the V‐DCC and DCC groups as a whole) could be determined from the paper and continuous data (e.g. duration of phototherapy) was calculated from unpublished data.
Notes	Study demonstrated the feasibility of the intervention. 95% of infants had at least 60 seconds of DCC. The majority of infants were delivered by caesarean section. Overall, 91% of participants established breathing before cord clamping. Subgroup analysis of mode of delivery and of infants who breathed during the procedure did not reveal significant differences.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Stratified, computer generated.
Allocation concealment (selection bias)	Low risk	Sealed opaque envelopes.
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	Not possible to blind personnel providing procedure at birth.
Blinding of outcome assessment (detection bias) All outcomes	Low risk	Neonatal team blinded to group allocation at birth.
Incomplete outcome data (attrition bias) All outcomes	Low risk	All participants accounted for.
Selective reporting (reporting bias)	Low risk	Prespecified outcomes presented.
Other bias	Low risk	None identified.

CPAP: continuous positive airway pressure; DCC: delayed cord clamping; PPV: positive pressure ventilation; SD: standard deviation; V‐DCC: delayed cord clamping with ventilation support.

Characteristics of excluded studies [ordered by study ID]

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Study	Reason for exclusion
Aladangady 2006	Control group randomized to early cord clamping.
Duley 2018	Control group randomized to immediate cord clamping.
Phillipos 2017	Observational study, non‐randomized intervention.
Winter 2017	Pilot feasibility study with no control group.

Characteristics of ongoing studies [ordered by study ID]

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ABC study (ACTRN12615001026516)

Trial name or title	Provision of Breathing Support during Delayed Cord Clamping in Preterm Infants.
Methods	Randomized controlled intervention trial with parallel assignment and masking of outcome assessment.
Participants	Inclusion criteria: preterm infants, < 31 weeks' gestation undergoing DCC (vaginal and caesarean births) deemed not to have established regular rhythmic breathing (chest wall movement) after 15 seconds of DCC. Exclusion criteria: known congenital abnormality, twin‐to‐twin transfusion syndrome, severe antenatal intrauterine growth restriction (estimated fetal weight < 10th customized centile), placental abruption, delivery of placenta and infant simultaneously (en caul), short umbilical cord, obstetrician refusal, declined antenatal consent.
Interventions	Intervention group: V‐DCC. Breathing support in form of PPV or CPAP delivered by facemask and T‐piece resuscitator. Infants will be randomized at 15 seconds of age once their breathing has been assessed. Breathing support will continue for 30 seconds while DCC is occurring (total of 50 seconds of DCC). Infants receiving breathing support will have a carbon dioxide calorimetric detection device inserted into the breathing circuit. Control group: DCC: no respiratory support before the cord is clamped at 50 seconds.
Outcomes	Primary outcome: red blood cell transfusion rate during the neonatal admission period. Secondary composite outcomes: chronic lung disease (respiratory support or use of supplemental oxygen at 36 weeks' corrected postnatal age), intraventricular haemorrhage (grade 3 or 4), and death (during the neonatal period). Other secondary outcomes: endotracheal intubation day 1, surfactant usage, admission temperature, echocardiographic assessment of transitional circulation, receipt of phototherapy, neonatal morbidity, length of hospital stay, and neurodevelopmental outcome at 2 years of age.
Starting date	February 2016.
Contact information	[email protected] ; [email protected].
Notes	Australia and New Zealand Clinical Trials Registry: ACTRN12615001026516. Currently recruiting. Expected completion: June 2019.

te Pas 2016 (NTR6095)

Trial name or title	Stabilisation of Preterm Infants with Intact Umbilical Cord, Aeration, Breathing, then Clamping: a Feasibility Study.
Methods	Safety and feasibility study.
Participants	Vaginal births 26‐35 weeks' gestation, planned recruitment of 15 infants.
Interventions	Intervention group: infants will be placed on the Con‐Cord table at the mother's bedside with monitoring and, with the umbilical cord intact, receive respiratory support according to local resuscitation guidelines. Control group: no respiratory support.
Outcomes	Safety and applicability.
Starting date	Registered September 2016.
Contact information	NTR6095.
Notes	Part of a wider ABC project ‐ the feasibility study has recently been completed and is to be followed by an effectiveness study, with the goal of subsequently performing a randomized trial.

VentFirst (NCT02742454)

Trial name or title	VentFirst: a Multicenter RCT of Assisted Ventilation during Delayed Cord Clamping for Extremely Preterm Infants.
Methods	Multicentre, randomized controlled intervention trial with parallel assignment and masking of outcomes assessment. Collaborators: Brigham and Women's Hospital, Mayo Clinic, St Louis University, University of Colorado, Denver; Royal Alexandra Hospital Oregon Health and Science University, University of Calgary.
Participants	Inclusion criteria: 23 weeks and 0 days to 28 weeks and 6 days' gestation at delivery. Exclusion criteria: life‐threatening condition of fetus (e.g. severe hydrops, lethal chromosomal abnormality, severe congenital malformation); suspected severe fetal anaemia; monochorionic or monoamniotic twins; multiple gestation greater than twins; decision made for comfort care only; medical emergency necessitating emergency delivery (e.g. complete placental abruption); obstetrician or neonatology concern for inappropriateness of the study intervention based on maternal or fetal factors.
Interventions	Intervention group: VentFirst (intervention) group will receive assisted ventilation (face mask, CPAP, or PPV) prior to cord clamping at 120 seconds. If the baby is not breathing well, PPV by face mask will be given at 30 seconds, if the baby is breathing well, CPAP by face mask will be given starting at 30 seconds. Control group: standard treatment group will receive DCC 30‐60 seconds after birth, and assisted ventilation after cord clamping. If the infant is not breathing well, cord will be clamped at 30 seconds, and if the baby is breathing well, cord will be clamped at 60 seconds.
Outcomes	Primary outcome: intraventricular haemorrhage on head ultrasound 7‐10 days after birth. Secondary outcomes: adverse events in delivery room (assessed at 1 hour after birth), adverse haematological and cardiovascular events (assessed within 24 hours of birth), adverse haematological and respiratory events (assessed within the first 10 days of birth), adverse prematurity‐related events up to 36 weeks' postmenstrual age; and adverse finding on late head ultrasound (birth to 36 weeks' postmenstrual age).
Starting date	June 2016.
Contact information	Amy K Camblos [email protected].
Notes	Planned enrolment of 940 infants (ClinicalTrials.gov: NCT02742454). Currently recruiting at 6 of 8 sites. Expected study completion June 2023.

CPAP: continuous positive airway pressure; DCC: delayed cord clamping; PPV: positive pressure ventilation; V‐DCC: delayed cord clamping with ventilation support.

Data and analyses

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Comparison 1. Respiratory support versus no respiratory support during delayed cord clamping in preterm infants

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Mortality during neonatal admission Show forest plot	1	150	Risk Ratio (M‐H, Fixed, 95% CI)	1.67 [0.41, 6.73]
Open in figure viewer Analysis 1.1 Comparison 1 Respiratory support versus no respiratory support during delayed cord clamping in preterm infants, Outcome 1 Mortality during neonatal admission.
2 Need for intubation in delivery room Show forest plot	1	150	Risk Ratio (M‐H, Fixed, 95% CI)	0.82 [0.55, 1.21]
Open in figure viewer Analysis 1.2 Comparison 1 Respiratory support versus no respiratory support during delayed cord clamping in preterm infants, Outcome 2 Need for intubation in delivery room.
3 Inotropic support for hypotension Show forest plot	1	150	Risk Ratio (M‐H, Fixed, 95% CI)	1.25 [0.63, 2.49]
Open in figure viewer Analysis 1.3 Comparison 1 Respiratory support versus no respiratory support during delayed cord clamping in preterm infants, Outcome 3 Inotropic support for hypotension.
4 Peak haematocrit in first 24 hours Show forest plot	1	150	Mean Difference (IV, Fixed, 95% CI)	0.20 [‐1.85, 2.25]
Open in figure viewer Analysis 1.4 Comparison 1 Respiratory support versus no respiratory support during delayed cord clamping in preterm infants, Outcome 4 Peak haematocrit in first 24 hours.
5 Blood transfusion during neonatal admission Show forest plot	1	150	Risk Ratio (M‐H, Fixed, 95% CI)	1.03 [0.70, 1.54]
Open in figure viewer Analysis 1.5 Comparison 1 Respiratory support versus no respiratory support during delayed cord clamping in preterm infants, Outcome 5 Blood transfusion during neonatal admission.
6 Phototherapy for hyperbilirubinaemia Show forest plot	1	150	Mean Difference (IV, Fixed, 95% CI)	0.20 [‐0.31, 0.71]
Open in figure viewer Analysis 1.6 Comparison 1 Respiratory support versus no respiratory support during delayed cord clamping in preterm infants, Outcome 6 Phototherapy for hyperbilirubinaemia.
7 Use of surfactant in the first 48 hours of life Show forest plot	1	150	Risk Ratio (M‐H, Fixed, 95% CI)	0.83 [0.54, 1.28]
Open in figure viewer Analysis 1.7 Comparison 1 Respiratory support versus no respiratory support during delayed cord clamping in preterm infants, Outcome 7 Use of surfactant in the first 48 hours of life.
8 Bronchopulmonary dysplasia Show forest plot	1	150	Risk Ratio (M‐H, Fixed, 95% CI)	1.1 [0.50, 2.43]
Open in figure viewer Analysis 1.8 Comparison 1 Respiratory support versus no respiratory support during delayed cord clamping in preterm infants, Outcome 8 Bronchopulmonary dysplasia.
9 Intraventricular haemorrhage (of any grade) Show forest plot	1	150	Risk Ratio (M‐H, Fixed, 95% CI)	1.5 [0.65, 3.46]
Open in figure viewer Analysis 1.9 Comparison 1 Respiratory support versus no respiratory support during delayed cord clamping in preterm infants, Outcome 9 Intraventricular haemorrhage (of any grade).
10 Severe intraventricular haemorrhage grade 3 or 4 Show forest plot	1	150	Risk Ratio (M‐H, Fixed, 95% CI)	1.33 [0.31, 5.75]
Open in figure viewer Analysis 1.10 Comparison 1 Respiratory support versus no respiratory support during delayed cord clamping in preterm infants, Outcome 10 Severe intraventricular haemorrhage grade 3 or 4.
11 Periventricular leukomalacia Show forest plot	1	150	Risk Ratio (M‐H, Fixed, 95% CI)	3.0 [0.12, 72.49]
Open in figure viewer Analysis 1.11 Comparison 1 Respiratory support versus no respiratory support during delayed cord clamping in preterm infants, Outcome 11 Periventricular leukomalacia.
12 Necrotizing enterocolitis ≥ Bell's stage 2 Show forest plot	1	150	Risk Ratio (M‐H, Fixed, 95% CI)	2.0 [0.19, 21.59]
Open in figure viewer Analysis 1.12 Comparison 1 Respiratory support versus no respiratory support during delayed cord clamping in preterm infants, Outcome 12 Necrotizing enterocolitis ≥ Bell's stage 2.
13 Retinopathy of prematurity requiring treatment Show forest plot	1	150	Risk Ratio (M‐H, Fixed, 95% CI)	2.0 [0.38, 10.59]
Open in figure viewer Analysis 1.13 Comparison 1 Respiratory support versus no respiratory support during delayed cord clamping in preterm infants, Outcome 13 Retinopathy of prematurity requiring treatment.
14 Sepsis Show forest plot	1	150	Risk Ratio (M‐H, Fixed, 95% CI)	1.67 [0.41, 6.73]
Open in figure viewer Analysis 1.14 Comparison 1 Respiratory support versus no respiratory support during delayed cord clamping in preterm infants, Outcome 14 Sepsis.
15 Pharmacological treatment for patent ductus arteriosus Show forest plot	1	150	Risk Ratio (M‐H, Fixed, 95% CI)	0.74 [0.40, 1.36]
Open in figure viewer Analysis 1.15 Comparison 1 Respiratory support versus no respiratory support during delayed cord clamping in preterm infants, Outcome 15 Pharmacological treatment for patent ductus arteriosus.
16 Surgical ligation for patent ductus arteriosus Show forest plot	1	150	Risk Ratio (M‐H, Fixed, 95% CI)	1.0 [0.26, 3.85]
Open in figure viewer Analysis 1.16 Comparison 1 Respiratory support versus no respiratory support during delayed cord clamping in preterm infants, Outcome 16 Surgical ligation for patent ductus arteriosus.

Figure 1

Study flow diagram.

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Figure 2

Forest plot of comparison: 1 Respiratory support versus no respiratory support during delayed cord clamping in preterm infants, outcome: 1.1 Mortality during neonatal admission.

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Figure 3

Forest plot of comparison: 1 Respiratory support versus no respiratory support during delayed cord clamping in preterm infants, outcome: 1.2 Need for intubation in delivery room.

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Figure 4

Forest plot of comparison: 1 Respiratory support versus no respiratory support during delayed cord clamping in preterm infants, outcome: 1.3 Inotropic support for hypotension.

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Figure 5

Forest plot of comparison: 1 Respiratory support versus no respiratory support during delayed cord clamping in preterm infants, outcome: 1.4 Peak haematocrit in first 24 hours [%].

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Figure 6

Forest plot of comparison: 1 Respiratory support versus no respiratory support during delayed cord clamping in preterm infants, outcome: 1.5 Blood transfusion during neonatal admission.

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Figure 7

Forest plot of comparison: 1 Respiratory support versus no respiratory support during delayed cord clamping in preterm infants, outcome: 1.6 Phototherapy for hyperbilirubinaemia [days].

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Figure 8

Forest plot of comparison: 1 Respiratory support versus no respiratory support during delayed cord clamping in preterm infants, outcome: 1.7 Use of surfactant in the first 48 hours of life.

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Figure 9

Forest plot of comparison: 1 Respiratory support versus no respiratory support during delayed cord clamping in preterm infants, outcome: 1.8 Bronchopulmonary dysplasia.

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Figure 10

Forest plot of comparison: 1 Respiratory support versus no respiratory support during delayed cord clamping in preterm infants, outcome: 1.9 Intraventricular haemorrhage (of any grade).

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Figure 11

Forest plot of comparison: 1 Respiratory support versus no respiratory support during delayed cord clamping in preterm infants, outcome: 1.10 Severe intraventricular haemorrhage grade 3 or 4.

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Analysis 1.1

Comparison 1 Respiratory support versus no respiratory support during delayed cord clamping in preterm infants, Outcome 1 Mortality during neonatal admission.

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Analysis 1.2

Comparison 1 Respiratory support versus no respiratory support during delayed cord clamping in preterm infants, Outcome 2 Need for intubation in delivery room.

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Analysis 1.3

Comparison 1 Respiratory support versus no respiratory support during delayed cord clamping in preterm infants, Outcome 3 Inotropic support for hypotension.

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Analysis 1.4

Comparison 1 Respiratory support versus no respiratory support during delayed cord clamping in preterm infants, Outcome 4 Peak haematocrit in first 24 hours.

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Analysis 1.5

Comparison 1 Respiratory support versus no respiratory support during delayed cord clamping in preterm infants, Outcome 5 Blood transfusion during neonatal admission.

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Analysis 1.6

Comparison 1 Respiratory support versus no respiratory support during delayed cord clamping in preterm infants, Outcome 6 Phototherapy for hyperbilirubinaemia.

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Analysis 1.7

Comparison 1 Respiratory support versus no respiratory support during delayed cord clamping in preterm infants, Outcome 7 Use of surfactant in the first 48 hours of life.

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Analysis 1.8

Comparison 1 Respiratory support versus no respiratory support during delayed cord clamping in preterm infants, Outcome 8 Bronchopulmonary dysplasia.

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Analysis 1.9

Comparison 1 Respiratory support versus no respiratory support during delayed cord clamping in preterm infants, Outcome 9 Intraventricular haemorrhage (of any grade).

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Analysis 1.10

Comparison 1 Respiratory support versus no respiratory support during delayed cord clamping in preterm infants, Outcome 10 Severe intraventricular haemorrhage grade 3 or 4.

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Analysis 1.11

Comparison 1 Respiratory support versus no respiratory support during delayed cord clamping in preterm infants, Outcome 11 Periventricular leukomalacia.

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Analysis 1.12

Comparison 1 Respiratory support versus no respiratory support during delayed cord clamping in preterm infants, Outcome 12 Necrotizing enterocolitis ≥ Bell's stage 2.

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Analysis 1.13

Comparison 1 Respiratory support versus no respiratory support during delayed cord clamping in preterm infants, Outcome 13 Retinopathy of prematurity requiring treatment.

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Analysis 1.14

Comparison 1 Respiratory support versus no respiratory support during delayed cord clamping in preterm infants, Outcome 14 Sepsis.

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Analysis 1.15

Comparison 1 Respiratory support versus no respiratory support during delayed cord clamping in preterm infants, Outcome 15 Pharmacological treatment for patent ductus arteriosus.

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Analysis 1.16

Comparison 1 Respiratory support versus no respiratory support during delayed cord clamping in preterm infants, Outcome 16 Surgical ligation for patent ductus arteriosus.

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Summary of findings for the main comparison. Respiratory support compared with no respiratory support before cord clamping in preterm infants

Respiratory support compared with no respiratory support before cord clamping in preterm infants
Patient or population: preterm infants Settings: undergoing delayed cord clamping Intervention: respiratory support Comparison: no respiratory support
Outcomes	Relative effect (95% CI)	No of participants	Quality of the evidence (GRADE)	Comments
Mortality ≤2 years after hospital discharge	RR 1.67 (0.41 to 6.73)	150	⊕⊕⊝⊝ Low¹	Secondary study outcome.
Inotropic support for hypotension	RR 1.25 (0.63 to 2.49)	150	⊕⊕⊝⊝ Low¹	‐
Peak haematocrit	MD 0.20 (‐1.85 to 2.25)	150	⊕⊕⊕⊝ Moderate³	Primary outcome.
Blood transfusion during neonatal admission	RR 1.03 (0.70 to 1.54)	150	⊕⊕⊕⊝ Moderate	40% with this outcome
Phototherapy for hyperbilirubinaemia	MD 0.20 (‐0.31 to 0.71)	150	⊕⊕⊕⊝ Moderate³	From unpublished data
Intraventricular haemorrhage (of any grade)	RR 1.50 (0.65 to 3.46)	150	⊕⊕⊝⊝ Low¹	Secondary outcome.
Severe intraventricular haemorrhage grade 3 or 4	RR 1.33 (0.31 to 5.75)	150	⊕⊝⊝⊝ Very low²	Uncommon secondary outcome.
CI: confidence interval; MD: mean difference; RR: risk ratio.
GRADE Working Group grades of evidence High quality: further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: we are very uncertain about the estimate.
In the published report, results were presented according to method of delivery. For categorical variables (e.g. mortality), the RR was calculated for the delayed cord clamping with ventilation support (intervention) and delayed cord clamping (control) groups as a whole. For continuous variables (e.g. haematocrit), the authors provided unpublished data that enabled whole group statistics to be determined. ¹Downgraded one level due to lack of precision with wide confidence intervals. ²Downgraded two levels due to lack of precision (confidence intervals included both important benefit and harm). The optimal information size for a 30% risk reduction with 80% power and 95% confidence intervals was 3280 infants per group. ³Unpublished data.

Summary of findings for the main comparison. Respiratory support compared with no respiratory support before cord clamping in preterm infants

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Comparison 1. Respiratory support versus no respiratory support during delayed cord clamping in preterm infants

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Mortality during neonatal admission Show forest plot	1	150	Risk Ratio (M‐H, Fixed, 95% CI)	1.67 [0.41, 6.73]

2 Need for intubation in delivery room Show forest plot	1	150	Risk Ratio (M‐H, Fixed, 95% CI)	0.82 [0.55, 1.21]

3 Inotropic support for hypotension Show forest plot	1	150	Risk Ratio (M‐H, Fixed, 95% CI)	1.25 [0.63, 2.49]

4 Peak haematocrit in first 24 hours Show forest plot	1	150	Mean Difference (IV, Fixed, 95% CI)	0.20 [‐1.85, 2.25]

5 Blood transfusion during neonatal admission Show forest plot	1	150	Risk Ratio (M‐H, Fixed, 95% CI)	1.03 [0.70, 1.54]

6 Phototherapy for hyperbilirubinaemia Show forest plot	1	150	Mean Difference (IV, Fixed, 95% CI)	0.20 [‐0.31, 0.71]

7 Use of surfactant in the first 48 hours of life Show forest plot	1	150	Risk Ratio (M‐H, Fixed, 95% CI)	0.83 [0.54, 1.28]

8 Bronchopulmonary dysplasia Show forest plot	1	150	Risk Ratio (M‐H, Fixed, 95% CI)	1.1 [0.50, 2.43]

9 Intraventricular haemorrhage (of any grade) Show forest plot	1	150	Risk Ratio (M‐H, Fixed, 95% CI)	1.5 [0.65, 3.46]

10 Severe intraventricular haemorrhage grade 3 or 4 Show forest plot	1	150	Risk Ratio (M‐H, Fixed, 95% CI)	1.33 [0.31, 5.75]

11 Periventricular leukomalacia Show forest plot	1	150	Risk Ratio (M‐H, Fixed, 95% CI)	3.0 [0.12, 72.49]

12 Necrotizing enterocolitis ≥ Bell's stage 2 Show forest plot	1	150	Risk Ratio (M‐H, Fixed, 95% CI)	2.0 [0.19, 21.59]

13 Retinopathy of prematurity requiring treatment Show forest plot	1	150	Risk Ratio (M‐H, Fixed, 95% CI)	2.0 [0.38, 10.59]

14 Sepsis Show forest plot	1	150	Risk Ratio (M‐H, Fixed, 95% CI)	1.67 [0.41, 6.73]

15 Pharmacological treatment for patent ductus arteriosus Show forest plot	1	150	Risk Ratio (M‐H, Fixed, 95% CI)	0.74 [0.40, 1.36]

16 Surgical ligation for patent ductus arteriosus Show forest plot	1	150	Risk Ratio (M‐H, Fixed, 95% CI)	1.0 [0.26, 3.85]

Comparison 1. Respiratory support versus no respiratory support during delayed cord clamping in preterm infants

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Referencias

Referencias de los estudios incluidos en esta revisión

Katheria 2016 {published and unpublished data}

Referencias de los estudios excluidos de esta revisión

Aladangady 2006 {published data only}

Duley 2018 {published data only}

Phillipos 2017 {published data only}

Winter 2017 {published data only}

Referencias de los estudios en curso

ABC study (ACTRN12615001026516) {published data only}

te Pas 2016 (NTR6095) {unpublished data only}

VentFirst (NCT02742454) {published data only}

Referencias adicionales

ACOG 2012

Al‐Wassia 2015

Baenziger 2007

Bell 1978

Bhatt 2013

Dawes 1953

Doyle 2010

Ersdal 2014

GRADEpro GDT [Computer program]

Groves 2008

Higgins 2011

Hooper 2015

Hosono 2008

Kakkilaya 2008

Katheria 2015

Kjeldsen 1967

Kluckow 2000

March 2013

McAdams 2014

McDonald 2013

Mercer 2006

Meyer 2012

Nevill 2015

Noori 2014

Oh 2011

Papile 1978

Perlman 2010

Philip 1973

Philip 1977

Rabe 2000

Rabe 2012

Raju 2013

Redmond 1965

Schünemann 2013

Sommers 2012

Soul 2007

van Bel 2008

Walsh 2004

Referencias de otras versiones publicadas de esta revisión

Meyer 2017

Characteristics of studies

Characteristics of included studies [ordered by study ID]

Characteristics of excluded studies [ordered by study ID]

Characteristics of ongoing studies [ordered by study ID]

Data and analyses

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