Chartrand Lily, Barrington Keith J, Dodin Philippe, Villeneuve Andréanne
Faculty of Medicine, Université de Montréal, Montréal, QC, Canada.
CHU Sainte-Justine, Montréal, QC, Canada; Division of Neonatology, Department of pediatrics.
Am J Obstet Gynecol. 2025 Mar;232(3):271-279.e1. doi: 10.1016/j.ajog.2024.10.024. Epub 2024 Oct 28.
To compare the effects of delayed cord clamping vs early cord clamping on all-cause in-hospital mortality and selected morbidities among preterm twin neonates.
A search of PubMed, Ovid Medline, Embase, Cochrane database, Web of Science, and CINAHL was conducted in December 2023 for studies comparing delayed cord clamping to immediate cord clamping in preterm twin neonates.
Studies were deemed eligible if they included preterm twin neonates (<37 weeks of gestation), compared delayed (≥30 seconds) vs early (<30 seconds) umbilical cord clamping at delivery and described at least one outcome of interest. Outcomes of interest were mortality, maternal hemorrhage, transfusion, severe interventricular hemorrhage (grade III or IV), bronchopulmonary dysplasia, necrotizing enterocolitis, retinopathy of prematurity (stage IV or receiving treatment), and length of hospital stay.
Two reviewers independently selected the studies, assessed bias and extracted data. Risk ratio and mean difference with 95% confidence intervals were determined by fixed effects models, heterogeneity by I statistics.
Five studies compared delayed cord clamping vs early cord clamping in 2075 infants. Meta-analysis showed a significant reduction in mortality [(risk ratio) 0.70 (95% confidence interval 0.53-0.93)], a significant decrease in the risk of red blood cell transfusion [(risk ratio) 0.42 (95% confidence interval 0.28-0.64)] as well as a lower risk of retinopathy of prematurity [(risk ratio) 0.50 (95% confidence interval 0.26-0.96)] with DCC in twin population. Delayed cord clamping had no impact on the incidence of intraventricular hemorrhage [(risk ratio) 1.01 (95% confidence interval 0.79, 1.28)], of bronchopulmonary dysplasia [(risk ratio) 0.67 (95% confidence interval 0.36, 1.24)], of necrotizing enterocolitis [(risk ratio) 1.02 (95% confidence interval 0.60, 1.73)]. There was no significant effect on length of hospital stay [-0.10 (-0.20, -0.00)]. None reported maternal hemorrhage.
Delayed cord clamping may decrease mortality risk in preterm twin infants without affecting major neonatal morbidities. Further evidence is needed to support its safety in preterm twins.
比较延迟脐带结扎与早期脐带结扎对早产双胎新生儿全因院内死亡率及特定疾病的影响。
2023年12月，检索了PubMed、Ovid Medline、Embase、Cochrane数据库、Web of Science和CINAHL，以查找比较早产双胎新生儿延迟脐带结扎与即刻脐带结扎的研究。
纳入的研究需包含早产双胎新生儿（孕周<37周），比较分娩时延迟（≥30秒）与早期（<30秒）脐带结扎，并描述至少一项感兴趣的结局。感兴趣的结局包括死亡率、产妇出血、输血、重度脑室内出血（III级或IV级）、支气管肺发育不良、坏死性小肠结肠炎、早产儿视网膜病变（IV期或接受治疗）以及住院时间。
两名评审员独立选择研究、评估偏倚并提取数据。采用固定效应模型确定风险比和95%置信区间的均值差，用I统计量评估异质性。
五项研究比较了2075例婴儿的延迟脐带结扎与早期脐带结扎。荟萃分析显示，延迟脐带结扎可显著降低死亡率[风险比为0.70（95%置信区间0.53 - 0.93）]，显著降低红细胞输血风险[风险比为0.42（95%置信区间0.28 - 0.64）]，以及降低双胎人群早产儿视网膜病变风险[风险比为0.50（95%置信区间0.26 - 0.96）]。延迟脐带结扎对脑室内出血发生率[风险比为1.01（95%置信区间0.79, 1.28）]、支气管肺发育不良发生率[风险比为0.67（95%置信区间0.36, 1.24）]、坏死性小肠结肠炎发生率[风险比为1.02（95%置信区间0.60, 1.73）]无影响。对住院时间无显著影响[-（均值差）0.10（95%置信区间-0.20, -0.00）]。均未报告产妇出血情况。
延迟脐带结扎可能降低早产双胎婴儿的死亡风险，且不影响主要的新生儿疾病发生情况。需要进一步的证据来支持其在早产双胎中的安全性。
