Evaluation of cord management strategies in intrauterine growth-restricted infants: a systematic review and meta-analysis.

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.