Effects of placental transfusion in extremely low birthweight   infants: meta-analysis of long- and short-term outcomes.
BACKGROUND
Risks and benefits of increasing placental transfusion in extremely preterm infants (extremely low birthweight [ELBW], <1000 g) are ill defined. We performed a meta-analysis to compare long- and short-term outcomes of ELBW infants in trials of enhanced placental transfusion regimens.


METHODS
We conducted a meta-analysis of randomized controlled trials (RCTs) of delayed umbilical cord clamping or umbilical cord milking in compliance with PRISMA and Cochrane Collaborative guidelines for systematic reviews. We searched multiple databases for medical literature up to December 2012. Inclusion criteria were preterm infants less than 30 weeks and less than 1000 g birthweight, randomly assigned to enhanced placental transfusion (either delayed cord clamping or cord milking) versus immediate cord clamping. The primary outcome was standardized neurodevelopmental outcome at 18 to 24 months corrected age using a standardized scale. Several short-term outcomes were also evaluated as secondary variables.


RESULTS
We found 19 studies of which 10 studies could be included (n = 199). Three reported neurodevelopmental outcomes, none of which showed significant rates of disability. Two reported these at 18 to 24 months (n = 42) but used different scales preventing pooling. Short-term benefits of enhanced placental strategies included better blood pressure and hemoglobin on admission, along with reduced blood transfusions, a trend to reduced intraventricular hemorrhage, and episodes of late-onset sepsis.


CONCLUSIONS
Strategies to enhance placental transfusion may improve short-term outcomes of ELBW infants. However, paucity of data on neurodevelopmental outcomes and safety concerns tempers enthusiasm for these interventions. Appropriately designed RCTs to assess short-term and longterm outcomes are needed in ELBW infants.
Sarvin
S
Ghavam
Dushyant
D
Batra
Judith
J
Mercer
Amir
A
Kugelman
Shigeharu
S
Hosono
William
W
Oh
Heike
H
Rabe
Haresh
H
Kirpalani
D001803:Blood Transfusion / Q000379:methods* / Q000706:statistics & numerical data; D002543:Cerebral Hemorrhage / Q000453:epidemiology / Q000517:prevention & control*; D003250:Constriction; D005260:Female; D006801:Humans; D052577:Infant, Extremely Low Birth Weight / Q000097:blood; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000453:epidemiology / Q000517:prevention & control; D010920:Placenta / Q000098:blood supply*; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D013997:Time Factors; D016896:Treatment Outcome; D014470:Umbilical Cord / Q000098:blood supply / Q000601:surgery