van Rheenen Patrick F, Gruschke Sebastian, Brabin Bernard J
Paediatrics Gastroenterology, Department of Paediatrics, University Medical Centre, Groningen, The Netherlands.
Ann Trop Paediatr. 2006 Sep;26(3):157-67. doi: 10.1179/146532806X120246.
Cheap and effective interventions are needed to reduce the risk of infant anaemia in developing countries. Delayed cord clamping (DCC) has been shown to be a simple, safe and cost-free delivery procedure that augments red cell mass in appropriate-for-gestational-age term and preterm infants. It is not known, however, whether DCC is similarly safe and effective in small-for-gestational-age (SGA) infants. We analysed the available evidence to generate a balanced inference on the use of DCC in developing countries.
To examine the short- and long-term effects in SGA infants of DCC compared with immediate clamping, and to assess the relationship between time of clamping and the potential postnatal haematological complications of DCC in SGA infants.
PubMed (1966 to January 2006), EMBASE (1988 to January 2006) and The Cochrane Library (Issue 1, 2006) were searched. Reference lists of published trials were examined and major journals of perinatal and tropical medicine were hand-searched.
Randomised and quasi-randomised trials comparing delayed with immediate cord clamping in infants born between 30 and 42 completed weeks of gestation and which included a proportion of SGA infants.
Three reviewers assessed eligibility and trial quality.
To date, no trials have specifically reported the effects of DCC in SGA infants. Three trials were included, of 190 term and 40 preterm infants, a proportion of whom were SGA. DCC was associated with higher haemoglobin levels in term infants at follow-up [two trials, 127 infants, weighted mean difference (WMD) 9.17 g/L, 95% confidence interval (CI) 5.94-12.40]. In preterm infants, the proportion who required a blood transfusion in the 1st 6 weeks after birth was lower after DCC (one trial, 38 infants, RR 0.56, 95% CI 0.34-0.94). It was not possible to infer from the available data whether SGA infants were at greater risk of adverse effects in the early neonatal period.
DCC in a group that contains both AGA and SGA infants was associated with higher haemoglobin levels at 2-3 months of age in term infants and a reduction in the number of blood transfusions needed in the 1st 4- 6 weeks of life in preterm infants. No reliable conclusions could be drawn about the potential adverse effects of DCC. The paucity of information on DCC in SGA infants justifies further research, especially in developing countries where the baseline risk for polycythaemia-hyperviscosity syndrome is likely to be lower than in industrialised countries.
发展中国家需要廉价且有效的干预措施来降低婴儿贫血风险。延迟脐带结扎（DCC）已被证明是一种简单、安全且免费的分娩程序，可增加适于胎龄的足月儿和早产儿的红细胞量。然而，尚不清楚DCC在小于胎龄（SGA）婴儿中是否同样安全有效。我们分析了现有证据，以便对发展中国家使用DCC做出全面的推断。
比较DCC与即刻结扎对SGA婴儿的短期和长期影响，并评估结扎时间与SGA婴儿DCC潜在的产后血液学并发症之间的关系。
检索了PubMed（1966年至2006年1月）、EMBASE（1988年至2006年1月）和考克兰图书馆（2006年第1期）。查阅了已发表试验的参考文献列表，并手工检索了围产期和热带医学的主要期刊。
比较妊娠30至42足周出生的婴儿中延迟脐带结扎与即刻脐带结扎的随机和半随机试验，且试验纳入了一定比例的SGA婴儿。
三名评审员评估了试验的合格性和质量。
迄今为止，尚无试验专门报告DCC对SGA婴儿的影响。纳入了三项试验，共190名足月儿和40名早产儿，其中部分为SGA婴儿。随访时，DCC与足月儿较高的血红蛋白水平相关[两项试验，127名婴儿，加权平均差（WMD）9.17g/L，95%置信区间（CI）5.94 - 12.40]。在早产儿中，DCC后出生后前6周需要输血的比例较低（一项试验，38名婴儿，RR 0.56，95%CI 0.34 - 0.94）。根据现有数据无法推断SGA婴儿在新生儿早期是否有更高的不良反应风险。
在包含适于胎龄和小于胎龄婴儿的群体中，DCC与足月儿2 - 3个月时较高的血红蛋白水平以及早产儿出生后前4 - 6周所需输血次数的减少有关。关于DCC的潜在不良反应无法得出可靠结论。关于SGA婴儿DCC的信息匮乏，有必要进一步开展研究，尤其是在多血症 - 高黏滞综合征基线风险可能低于工业化国家的发展中国家。
