Systematic review and meta-analysis finds no clear benefit or harm for umbilical cord strategies on IVH risk in preterm neonates.
This is a systematic review and meta-analysis of randomized controlled trials evaluating umbilical cord management strategies in preterm neonates born before 37 weeks. The review synthesized evidence on strategies including delayed cord clamping, intact cord milking, and physiology-based cord clamping, with a primary focus on any grade and severe intraventricular hemorrhage (IVH).
The meta-analysis included 8,706 neonates across multiple studies. For delayed versus immediate cord clamping, there was no clear evidence of benefit or harm for any grade IVH (RR 0.90, 95% CI 0.65 to 1.26, 14 studies) or severe IVH (RR 1.14, 95% CI 0.69 to 1.87, 11 studies). Compared to intact umbilical cord milking, delayed clamping showed no benefit for any grade IVH (RR 1.03, 95% CI 0.80 to 1.32, eight studies, 2200 participants) or severe IVH (RR 0.77, 95% CI 0.35 to 1.66, seven studies, 2032 participants). Intact cord stabilization versus delayed clamping also showed no clear evidence of benefit or harm for any grade IVH (RR 0.96, 95% CI 0.82 to 1.13) or severe IVH (RR 0.91, 95% CI 0.62 to 1.35).
The authors noted that the certainty of evidence ranged from moderate to very low, often downgraded due to imprecision, risk of bias, and inconsistency. No adverse events were reported in the included studies. The review did not identify a clear association between any umbilical cord management strategy and IVH risk.
Practice relevance is limited by the low certainty of evidence. Clinicians should interpret these findings cautiously, as no strategy was clearly superior or harmful.
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