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 meta-analysis. 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 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%CI: 0.31-1.25), 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. Key words: Infant, very low birth weight; Blood transfusion; Placental circulation; Umbilical cord; Ligation; Constriction; Meta-analysis
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