Pediatric Residency, Department of Pediatrics, The Ohio State University College of Medicine/Nationwide Children's Hospital, Columbus, OH, USA.
Center for Perinatal Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
Semin Perinatol. 2023 Jun;47(4):151745. doi: 10.1016/j.semperi.2023.151745. Epub 2023 Mar 17.
Umbilical cord clamping practices impact nearly 140 million births each year. Current evidence has led professional organizations to recommend delayed cord clamping (DCC), as opposed to early cord clamping (ECC), as the standard of care in uncomplicated term and preterm deliveries. However, variability remains in cord management practices for maternal-infant dyads at higher risk of complications. This review examines the current state of evidence on the outcomes of at-risk infant populations receiving differing umbilical cord management strategies. Review of contemporary literature demonstrates members of high-risk neonatal groups, including those affected by small for gestational age (SGA) classification, intrauterine growth restriction (IUGR), maternal diabetes, and Rh-isoimmunization, are frequently excluded from participation in clinical trials of cord clamping strategies. Furthermore, when these populations are included, outcomes are often underreported. Consequently, evidence regarding optimal umbilical cord management in at-risk groups is limited, and further research is needed to guide best clinical practice.
脐带夹闭实践每年影响近 1.4 亿例分娩。目前的证据促使专业组织建议延迟脐带夹闭（DCC），而不是早期脐带夹闭（ECC），作为复杂足月和早产儿分娩的护理标准。然而，对于存在并发症风险的母婴对子，脐带管理实践仍然存在差异。本综述考察了目前接受不同脐带管理策略的高危婴儿人群的结局证据。对当代文献的回顾表明，高危新生儿群体的成员，包括那些受胎儿生长受限（IUGR）、母体糖尿病和 Rh 同种免疫影响的成员，经常被排除在脐带夹闭策略的临床试验之外。此外，当这些人群被包括在内时，结果往往报告不足。因此，关于高危人群最佳脐带管理的证据有限，需要进一步研究来指导最佳临床实践。
