scholarly journals Interventions to minimize blood loss in very preterm infants—A systematic review and meta-analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0246353
Author(s):  
Emma Persad ◽  
Greta Sibrecht ◽  
Martin Ringsten ◽  
Simon Karlelid ◽  
Olga Romantsik ◽  
...  
Keyword(s):  
Systematic Review ◽  
Blood Loss ◽  
Preterm Infants ◽  
Data Extraction ◽  
Meta Analysis ◽  
Blood Sampling ◽  
Delayed Cord Clamping ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Cord Clamping

Blood loss in the first days of life has been associated with increased morbidity and mortality in very preterm infants. In this systematic review we included randomized controlled trials comparing the effects of interventions to preserve blood volume in the infant from birth, reduce the need for sampling, or limit the blood sampled. Mortality and major neurodevelopmental disabilities were the primary outcomes. Included studies underwent risk of bias-assessment and data extraction by two review authors independently. We used risk ratio or mean difference to evaluate the treatment effect and meta-analysis for pooled results. The certainty of evidence was assessed using GRADE. We included 31 trials enrolling 3,759 infants. Twenty-five trials were pooled in the comparison delayed cord clamping or cord milking vs. immediate cord clamping or no milking. Increasing placental transfusion resulted in lower mortality during the neonatal period (RR 0.51, 95% CI 0.26 to 1.00; participants = 595; trials = 5; I2 = 0%, moderate certainty of evidence) and during first hospitalization (RR 0.70, 95% CI 0.51, 0.96; 10 RCTs, participants = 2,476, low certainty of evidence). The certainty of evidence was very low for the other primary outcomes of this review. The six remaining trials compared devices to monitor glucose levels (three trials), blood sampling from the umbilical cord or from the placenta vs. blood sampling from the infant (2 trials), and devices to reintroduce the blood after analysis vs. conventional blood sampling (1 trial); the certainty of evidence was rated as very low for all outcomes in these comparisons. Increasing placental transfusion at birth may reduce mortality in very preterm infants; However, extremely limited evidence is available to assess the effects of other interventions to reduce blood loss after birth. In future trials, infants could be randomized following placental transfusion to different blood saving approaches. Trial registration: PROSPERO CRD42020159882.

scholarly journals Effect of Family-centered Care Interventions on Motor and Neurobehavior Development of Very Preterm Infants: A Protocol of Systematic Review

2020 ◽  
Author(s):  
Manasa Kolibylu Raghupathy ◽  
Bhamini Krishna Rao ◽  
Shubha R Nayak ◽  
Alicia J Spittle ◽  
Shradha S Parsekar
Keyword(s):  
Systematic Review ◽  
Preterm Infants ◽  
Infant Development ◽  
Data Extraction ◽  
Meta Analysis ◽  
Health Concern ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Very Preterm Infants ◽  
Very Preterm

Abstract Background: Globally, preterm birth is a health concern leading to various developmental difficulties such as poor motor and/or cognitive function. For infants born preterm, FCC promotes developmental skills over the time in an appropriate enriched environment. The purpose of this study is to systematically review and assess the evidence of FCC interventions on motor and neurobehavioral development in very preterm infants. Additionally, this review aims to determine the factors that might affect the infant development.Methods: Systematic review will be carried out by including quasi-experimental controlled trials and randomized controlled trials. Electronic databases such as Scopus, PubMed, EMBASE, Cochrane Library, Web of Science, CINAHL, and PsycINFO will be searched using database specific terms. Additionally, searches will be carried out in ProQuest, and references of included studies will be searched. Two review authors, independently, will conduct the screening, data extraction, and critical appraisal of included studies. If possible, meta-analysis will be undertaken to assess the effect of FCC on motor and neurobehavior of premature infants.Conclusion: The review will provide insights regarding the effect of the FCC on preterm infants. This systematic review will guide the clinicians on the feasibility of practicing FCC that might support and promote the integration of parents into various rehabilitation settings.Systematic review registration: Protocol has been submitted to PROSPERO on July 26, 2020.

Effect of delayed cord clamping on very preterm infants

2015 ◽  
Vol 213 (5) ◽  
pp. 676.e1-676.e7 ◽  
Author(s):  
Arpitha Chiruvolu ◽  
Veeral N. Tolia ◽  
Huanying Qin ◽  
Genna Leal Stone ◽  
Diana Rich ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Delayed Cord Clamping ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Cord Clamping

scholarly journals Donor Human Milk Protects against Bronchopulmonary Dysplasia: A Systematic Review and Meta-Analysis

2018 ◽  
Author(s):  
Eduardo Villamor-Martínez ◽  
Maria Pierro ◽  
Giacomo Cavallaro ◽  
Fabio Mosca ◽  
Boris W. Kramer ◽  
...  
Keyword(s):  
Systematic Review ◽  
Human Milk ◽  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Observational Studies ◽  
Meta Analysis ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Donor Human Milk ◽  
Preterm Formula

Bronchopulmonary dysplasia (BPD) is the most common complication after preterm birth. Pasteurized donor human milk (DHM) has increasingly become the standard of care for very preterm infants over the use of preterm formula (PF) if mother’s own milk (MOM) is unavailable. Studies have reported beneficial effects of DHM on BPD. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies on the effects of DHM on BPD and other respiratory outcomes. Eighteen studies met the inclusion criteria. Meta-analysis of RCT’s could not demonstrate that supplementation of MOM with DHM reduced BPD when compared to PF (3 studies, risk ratio [RR] 0.89, 95% confidence interval [CI] 0.60–1.32). However, meta-analysis of observational studies showed that DHM supplementation reduced BPD (8 studies, RR 0.78, 95% CI 0.67–0.90). An exclusive human milk diet reduced the risk of BPD, compared to a diet with PF and/or bovine milk-based fortifier (3 studies, RR 0.80, 95% CI 0.68–0.95). Feeding raw MOM, compared to feeding pasteurized MOM, protected against BPD (2 studies, RR 0.77, 95% CI 0.62–0.96). In conclusion, our data suggest that DHM protects against BPD in very preterm infants, but pasteurization of human milk reduces the benefit.

Effect of Delayed Cord Clamping on Cerebral Oxygenation in Very Preterm Infants

Neonatology ◽  
2018 ◽  
Vol 115 (1) ◽  
pp. 13-20 ◽  
Author(s):  
Himanshu Popat ◽  
Claire Galea ◽  
Nicholas Evans ◽  
Barbara Lingwood ◽  
Paul B. Colditz ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Cerebral Oxygenation ◽  
Delayed Cord Clamping ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Cord Clamping

scholarly journals Benefits of umbilical cord milking versus delayed cord clamping on neonatal outcomes in preterm infants: A systematic review and meta-analysis

PLoS ONE ◽  
2018 ◽  
Vol 13 (8) ◽  
pp. e0201528 ◽  
Author(s):  
Nobuhiko Nagano ◽  
Makoto Saito ◽  
Takahiro Sugiura ◽  
Fumiko Miyahara ◽  
Fumihiko Namba ◽  
...  
Keyword(s):  
Systematic Review ◽  
Preterm Infants ◽  
Umbilical Cord ◽  
Meta Analysis ◽  
Neonatal Outcomes ◽  
Delayed Cord Clamping ◽  
Cord Clamping ◽  
Umbilical Cord Milking

scholarly journals Umbilical cord milking in preterm infants: a systematic review and meta-analysis

2020 ◽  
Vol 105 (6) ◽  
pp. 572-580
Author(s):  
Haribalakrishna Balasubramanian ◽  
Anitha Ananthan ◽  
Vaibhav Jain ◽  
Shripada C Rao ◽  
Nandkishor Kabra
Keyword(s):  
Systematic Review ◽  
Preterm Infants ◽  
Umbilical Cord ◽  
Meta Analysis ◽  
Intraventricular Haemorrhage ◽  
Reference List ◽  
Delayed Cord Clamping ◽  
Neurodevelopmental Outcomes ◽  
Cord Clamping ◽  
Umbilical Cord Milking

ObjectiveTo conduct a systematic review and meta-analysis of the efficacy and safety of umbilical cord milking in preterm infants.DesignRandomised controlled trials comparing umbilical cord milking with delayed cord clamping/immediate cord clamping in preterm infants were identified by searching databases, clinical trial registries and reference list of relevant studies in November 2019. Fixed effects model was used to pool the data on various clinically relevant outcomes.Main outcome measuresMortality and morbidities in preterm neonates.ResultsNineteen studies (2014 preterm infants) were included. Five studies (n=922) compared cord milking with delayed cord clamping, whereas 14 studies (n=1092) compared milking with immediate cord clamping. Cord milking, as opposed to delayed cord clamping, significantly increased the risk of intraventricular haemorrhage (grade III or more) (risk ratio (RR): 1.95 (95% CI 1.01 to 3.76), p=0.05). When compared with immediate cord clamping, cord milking reduced the need for packed RBC transfusions (RR:0.56 (95% CI 0.43 to 0.73), p<0.001). There was limited information on long-term neurodevelopmental outcomes. The grade of evidence was moderate or low for the various outcomes analysed.ConclusionUmbilical cord milking, when compared with delayed cord clamping, significantly increased the risk of severe intraventricular haemorrhage in preterm infants, especially at lower gestational ages. Cord milking, when compared with immediate cord clamping, reduced the need for packed RBC transfusions but did not improve clinical outcomes. Hence, cord milking cannot be considered as placental transfusion strategy in preterm infants based on the currently available evidence.

Outcomes of very preterm infants with neonatal hyperglycaemia: a systematic review and meta-analysis

2021 ◽  
pp. fetalneonatal-2020-321449
Author(s):  
Chandra Prakash Rath ◽  
Madhusudhan Shivamallappa ◽  
Saravanan Muthusamy ◽  
Shripada C Rao ◽  
Sanjay Patole
Keyword(s):  
Systematic Review ◽  
Cohort Studies ◽  
Preterm Infants ◽  
Meta Analysis ◽  
Case Control ◽  
Small Sample ◽  
Adverse Outcomes ◽  
Preterm Neonates ◽  
Very Preterm Infants ◽  
Very Preterm

ObjectiveTo explore the association between hyperglycaemia and adverse outcomes in very preterm infants.DesignSystematic review and meta-analysis. Data were pooled separately for adjusted and unadjusted odds ratios (ORs) using random-effects model. Subgroup analysis was conducted based on study design (cohort and case control).Main outcome measuresAssociation between hyperglycaemia in preterm neonates (<32 weeks or <1500 g) and mortality and morbidities.FindingsForty-six studies (30 cohort and 16 case control) with data from 34 527 infants were included. Meta-analysis of unadjusted ORs from cohort studies found hyperglycaemia to be significantly associated with mortality, any-grade intraventricular haemorrhage (IVH), severe IVH, any-stage retinopathy of prematurity (ROP), severe ROP, sepsis, chronic lung disease and disability. However, pooling of adjusted ORs found significant associations only for mortality (adjusted OR (CI): 2.37 (1.40 to 4.01); I2: 36%; 6 studies), ‘Any grade IVH’ (adjusted OR (CI): 2.60 (1.09 to 6.20); I2: 0%; 2 studies) and ‘Any stage ROP’ (adjusted OR (CI): 3.70 (1.55 to 8.84); I2: 0%; 2 studies). Meta-regression analysis found glucose levels >10 mmol/L to be associated with increased odds of mortality compared with <10 mmol/L. Pooled analysis from case–control studies were similar to cohort studies for most outcomes but limited by small sample size. Longer duration of hyperglycaemia was associated with adverse outcomes. GRADE of evidence was ‘Low’ or ‘Very low’.ConclusionHyperglycaemia in very preterm infants is associated with higher odds of mortality, any-grade IVH and any-stage ROP. A limitation was lack of availability of adjusted ORs from many of the included studies.PROSPERO registration numberCRD42020193016.

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