Aldemerdash Mohamed A, Abdellatif Mohammed, Roshdy Merna Raafat, Zakaria Asmaa, Bayoumi Ahmed, Hasan Mohammed Tarek, AbuSammour Yaser, Aldemerdash Ahmed, Mashaly Doaa, Hamouda Naema
Faculty of Medicine, Sohag University, Sohag, Egypt.
Medical Research Group of Egypt, Negida Academy, Arlington, MA, USA.
Eur J Pediatr. 2025 Jan 10;184(2):125. doi: 10.1007/s00431-024-05956-y.
Delayed cord clamping (DCC) has been widely adopted in both term and preterm infants to improve neonatal outcomes by increasing blood volume and supporting oxygenation. However, the optimal cord management for intrauterine growth-restricted (IUGR) infants is unclear. To systematically review and meta-analyze the effects of DCC compared to early cord clamping (ECC) in IUGR infants. We followed the PRISMA guidelines for meta-analysis. Six databases were searched for randomized controlled trials (RCTs) and observational studies comparing DCC and ECC in IUGR infants, focusing on neonatal resuscitation measures, hematological parameters, morbidities, and mortality. The Cochrane Collaboration tool and Newcastle-Ottawa scale were used for RCTs and observational studies, respectively. Eight studies with 1531 participants were included, comprising six RCTs and two observational studies. Serum ferritin at 3 months and initial Hb were significantly higher in the DCC group (MD: 36.16 ng/ml [95% CI: 34.09, 38.24]), (MD: 1.64 gm/dl [95%CI: 0.88, 2.4]) respectively. The risk of polycythemia was higher in the DCC group (RR 1.88, 95% CI [1.27, 2.8]), without an increase in the peak total serum bilirubin or the need for exchange transfusion. Conclusion: DCC may be beneficial and safe in IUGR infants, improving hematological parameters without affecting neonatal morbidity and mortality. Further high-quality, large trials are needed to confirm these findings and assess neurodevelopmental impact.
延迟脐带结扎（DCC）已在足月儿和早产儿中广泛采用，通过增加血容量和支持氧合作用来改善新生儿结局。然而，对于宫内生长受限（IUGR）婴儿的最佳脐带管理尚不清楚。为了系统评价和荟萃分析与早期脐带结扎（ECC）相比，DCC对IUGR婴儿的影响。我们遵循PRISMA荟萃分析指南。检索了六个数据库，以查找比较IUGR婴儿中DCC和ECC的随机对照试验（RCT）和观察性研究，重点关注新生儿复苏措施、血液学参数、发病率和死亡率。分别使用Cochrane协作工具和纽卡斯尔-渥太华量表对RCT和观察性研究进行评价。纳入了八项研究，共1531名参与者，包括六项RCT和两项观察性研究。DCC组3个月时的血清铁蛋白和初始血红蛋白水平显著更高（MD：36.16 ng/ml [95% CI：34.09，38.24]），（MD：1.64 gm/dl [95%CI：0.88，2.4]）。DCC组红细胞增多症的风险更高（RR 1.88，95% CI [1.27，2.8]），而总血清胆红素峰值或换血需求并未增加。结论：DCC对IUGR婴儿可能有益且安全，可改善血液学参数，而不影响新生儿发病率和死亡率。需要进一步开展高质量、大规模试验来证实这些发现并评估对神经发育的影响。
