目的 分析脐带挤压与延迟断脐对胎龄<34周早产儿早期预后的影响。 方法 计算机检索PubMed、Web of Science、Embase、Cochrane Library、CINAHL、中国知网、万方数据库、维普数据库和中国生物医学文献服务系统数据库从建库到2021年11月发表的胎龄<34周早产儿脐带挤压与延迟断脐的随机对照试验。由2名研究人员根据纳入和排除标准，独立对文献进行筛选和质量评价，并提取数据，采用Review Manger 5.4进行Meta分析。 结果 最终纳入11篇文献，共1 621例早产儿，其中脐带挤压组809例，延迟断脐组812例。Meta分析结果显示，与延迟断脐相比，脐带挤压提高了早产儿出生后平均血压（WMD=3.61，95%CI：0.73~6.50，P=0.01），但增加了早产儿严重脑室内出血的发生率（RR=1.83，95%CI：1.08~3.09，P=0.02），两者在早产儿出生后血红蛋白水平、红细胞压积、输血率、光疗率、血清胆红素峰值及脑室周围白质软化、坏死性小肠结肠炎等并发症发生的影响差异均无统计学意义（P>0.05）。 结论 与延迟断脐相比，脐带挤压可能增加胎龄<34周早产儿严重脑室内出血的风险，但仍需更多高质量、大样本的随机对照试验进一步证实。 引用格式：中国当代儿科杂志，2022，24（5）：492-499
Abstract
Objective To study the influence of umbilical cord milking versus delayed cord clamping on the early prognosis of preterm infants with a gestational age of <34 weeks. Methods PubMed, Web of Science, Embase, the Cochrane Library, CINAHL, China National Knowledge Infrastructure, Wanfang Data, Weipu Database, and SinoMed were searched for randomized controlled trials on umbilical cord milking versus delayed cord clamping in preterm infants with a gestational age of <34 weeks published up to November 2021. According to the inclusion and exclusion criteria, two researchers independently performed literature screening, quality evaluation, and data extraction. Review Manger 5.4 was used for Meta analysis. Results A total of 11 articles were included in the analysis, with 1 621 preterm infants in total, among whom there were 809 infants in the umbilical cord milking group and 812 in the delayed cord clamping group. The Meta analysis showed that compared with delayed cord clamping, umbilical cord milking increased the mean blood pressure after birth (weighted mean difference=3.61, 95%CI: 0.73-6.50, P=0.01), but it also increased the incidence rate of severe intraventricular hemorrhage (RR=1.83, 95%CI: 1.08-3.09, P=0.02). There were no significant differences between the two groups in hemoglobin, hematocrit, blood transfusion rate, proportion of infants undergoing phototherapy, bilirubin peak, and incidence rates of complications such as periventricular leukomalacia and necrotizing enterocolitis (P>0.05). Conclusions Compared with delayed cord clamping, umbilical cord milking may increase the risk of severe intraventricular hemorrhage in preterm infants with a gestational age of <34 weeks; however, more high-quality large-sample randomized controlled trials are needed for further confirmation. Citation:Chinese Journal of Contemporary Pediatrics, 2022, 24(5): 492-499
关键词
脐带挤压 /
延迟断脐 /
脑室内出血 /
胎盘输血 /
Meta分析 /
早产儿
Key words
Umbilical cord milking /
Delayed cord clamping /
Intraventricular hemorrhage /
Placental transfusion /
Meta analysis /
Preterm infant
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参考文献
1 Tarnow-Mordi W, Morris J, Kirby A, et al. Delayed versus immediate cord clamping in preterm infants[J]. N Engl J Med, 2017, 377(25): 2445-2455. PMID: 29081267. DOI: 10.1056/NEJMoa1711281.
2 George AA, Isac M. Effect of umbilical cord milking on maternal and neonatal outcomes in a tertiary care hospital in South India: a randomized control trial[J]. J Obstet Gynaecol India, 2021. Epub ahead of print. DOI: 10.1007/s13224-021-01515-9.
3 Committee on Obstetric Practice, American College of Obstetricians and Gynecologists. Committee Opinion No.543: timing of umbilical cord clamping after birth[J]. Obstet Gynecol, 2012, 120(6): 1522-1526. PMID: 23168790. DOI: 10.1097/01.AOG.0000423817.47165.48.
4 Katheria AC, Lakshminrusimha S, Rabe H, et al. Placental transfusion: a review[J]. J Perinatol, 2017, 37(2): 105-111. PMID: 27654493. PMCID: PMC5290307. DOI: 10.1038/jp.2016.151.
5 World Health Organization. Guidelines on basic newborn resuscitation[EB/OL]. [2021-12-02]. https://www.who.int/publications-detail-redirect/9789241503693.
6 Aziz K, Lee HC, Escobedo MB, et al. Part 5: Neonatal resuscitation: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care[J]. Circulation, 2020, 142(16_suppl_2): S524-S550. PMID: 33081528. DOI: 10.1161/CIR.0000000000000902.
7 Fogarty M, Osborn DA, Askie L, et al. Delayed vs early umbilical cord clamping for preterm infants: a systematic review and meta-analysis[J]. Am J Obstet Gynecol, 2018, 218(1): 1-18. PMID: 29097178. DOI: 10.1016/j.ajog.2017.10.231.
8 Rabe H, Reynolds G, Diaz-Rossello J. Early versus delayed umbilical cord clamping in preterm infants[J]. Cochrane Database Syst Rev, 2004(4): CD003248. PMID: 15495045. DOI: 10.1002/14651858.CD003248.pub2.
9 Rabe H, Gyte GM, Díaz-Rossello JL, et al. Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes[J]. Cochrane Database Syst Rev, 2019, 9(9): CD003248. PMID: 31529790. PMCID: PMC6748404. DOI: 10.1002/14651858.CD003248.pub4.
10 Shirk SK, Manolis SA, Lambers DS, et al. Delayed clamping vs milking of umbilical cord in preterm infants: a randomized controlled trial[J]. Am J Obstet Gynecol, 2019, 220(5): 482.e1-482.e8. PMID: 30786254. DOI: 10.1016/j.ajog.2019.01.234.
11 Sura M, Osoti A, Gachuno O, et al. Effect of umbilical cord milking versus delayed cord clamping on preterm neonates in Kenya: a randomized controlled trial[J]. PLoS One, 2021, 16(1): e0246109. PMID: 33497396. PMCID: PMC7837492. DOI: 10.1371/journal.pone.0246109.
12 Nagano N, Saito M, Sugiura T, et al. Benefits of umbilical cord milking versus delayed cord clamping on neonatal outcomes in preterm infants: a systematic review and meta-analysis[J]. PLoS One, 2018, 13(8): e0201528. PMID: 30161139. PMCID: PMC6116944. DOI: 10.1371/journal.pone.0201528.
13 Katheria A, Garey D, Truong G, et al. A randomized clinical trial of umbilical cord milking vs delayed cord clamping in preterm infants: neurodevelopmental outcomes at 22-26 months of corrected age[J]. J Pediatr, 2018, 194: 76-80. PMID: 29246467. DOI: 10.1016/j.jpeds.2017.10.037.
14 Katheria A, Reister F, Essers J, et al. Association of umbilical cord milking vs delayed umbilical cord clamping with death or severe intraventricular hemorrhage among preterm infants[J]. JAMA, 2019, 322(19): 1877-1886. PMID: 31742630. PMCID: PMC6865839. DOI: 10.1001/jama.2019.16004.
15 Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0[EB/OL]. [2021-12-05]. https://training.cochrane.org/handbook/archive/v5.1/.
16 Katheria AC, Szychowski JM, Essers J, et al. Early cardiac and cerebral hemodynamics with umbilical cord milking compared with delayed cord clamping in infants born preterm[J]. J Pediatr, 2020, 223: 51-56.e1. PMID: 32482392. PMCID: PMC7387184. DOI: 10.1016/j.jpeds.2020.04.010.
17 Finn D, Ryan DH, Pavel A, et al. Clamping the umbilical cord in premature deliveries (CUPiD): neuromonitoring in the immediate newborn period in a randomized, controlled trial of preterm infants born at <32 weeks of gestation[J]. J Pediatr, 2019, 208: 121-126.e2. PMID: 30879732. DOI: 10.1016/j.jpeds.2018.12.039.
18 Katheria AC, Truong G, Cousins L, et al. Umbilical cord milking versus delayed cord clamping in preterm infants[J]. Pediatrics, 2015, 136(1): 61-69. PMID: 26122803. PMCID: PMC4485011. DOI: 10.1542/peds.2015-0368.
19 Pratesi S, Montano S, Ghirardello S, et al. Placental circulation intact trial (PCI-T)-resuscitation with the placental circulation intact vs. cord milking for very preterm infants: a feasibility study[J]. Front Pediatr, 2018, 6: 364. PMID: 30538975. PMCID: PMC6277460. DOI: 10.3389/fped.2018.00364.
20 林玲, 彭好. 脐带延迟结扎和脐带挤压输血对早产儿脑血流动力学的影响: 一项随机双盲对照试验[J]. 中国当代儿科杂志, 2021, 23(4): 332-337. PMID: 33840403. PMCID: PMC8050552. DOI: 10.7499/j.issn.1008-8830.2011158.
21 石爽, 梁振新, 樊天云, 等. 延迟脐带结扎与脐带挤压对胎龄<34周早产儿的影响[J]. 中国计划生育学杂志, 2021, 29(2): 292-295. DOI: 10.3969/j.issn.1004-8189.2021.02.020.
22 喻玲, 许柳, 赵怡然, 等. 不同脐带结扎方式对早产儿黄疸及血液系统的影响[J]. 河北医科大学学报, 2020, 41(12): 1428-1431. DOI: 10.3969/j.issn.1007-3205.2020.12.014.
23 Rabe H, Jewison A, Fernandez Alvarez R, et al. Milking compared with delayed cord clamping to increase placental transfusion in preterm neonates: a randomized controlled trial[J]. Obstet Gynecol, 2011, 117(2 Pt 1): 205-211. PMID: 21252731. DOI: 10.1097/AOG.0b013e3181fe46ff.
24 Krueger MS, Eyal FG, Peevy KJ, et al. Delayed cord clamping with and without cord stripping: a prospective randomized trial of preterm neonates[J]. Am J Obstet Gynecol, 2015, 212(3): 394.e1-394.e5. PMID: 25526873. DOI: 10.1016/j.ajog.2014.12.017.
25 樊雪梅. 不同断脐方法对胎龄<32周早产儿影响的研究[D]. 南京: 南京中医药大学, 2018.
26 姜梦雪. 挤压脐带胎盘输血对经剖宫产分娩早产儿的影响[D]. 长春: 吉林大学, 2019.
27 Takami T, Suganami Y, Sunohara D, et al. Umbilical cord milking stabilizes cerebral oxygenation and perfusion in infants born before 29 weeks of gestation[J]. J Pediatr, 2012, 161(4): 742-747. PMID: 22578578. DOI: 10.1016/j.jpeds.2012.03.053.
28 Balasubramanian H, Ananthan A, Jain V, et al. Umbilical cord milking in preterm infants: a systematic review and meta-analysis[J]. Arch Dis Child Fetal Neonatal Ed, 2020, 105(6): 572-580. PMID: 32152192. DOI: 10.1136/archdischild-2019-318627.
29 Gilard V, Tebani A, Bekri S, et al. Intraventricular hemorrhage in very preterm infants: a comprehensive review[J]. J Clin Med, 2020, 9(8): 2447. PMID: 32751801. PMCID: PMC7465819. DOI: 10.3390/jcm9082447.
30 毛健. 新生儿颅内出血[J]. 中国实用儿科杂志, 2005, 20(6): 377-380. DOI: 10.3969/j.issn.1005-2224.2005.06.024.
31 Blank DA, Polglase GR, Kluckow M, et al. Haemodynamic effects of umbilical cord milking in premature sheep during the neonatal transition[J]. Arch Dis Child Fetal Neonatal Ed, 2018, 103(6): F539-F546. PMID: 29208663. PMCID: PMC6278653. DOI: 10.1136/archdischild-2017-314005.
32 孙大庆, 张秋业. 新生儿颅内出血研究进展[J]. 新医学, 2004, 35(11): 663-665. DOI: 10.3969/j.issn.0253-9802.2004.11.007.
33 牛峰海, 王瑜, 任雪云, 等. 挤压脐带及延迟脐带结扎对早产儿平均血压、脑血流及新生儿神经行为测定评分的影响[J]. 吉林医学, 2016, 37(12): 2900-2902. DOI: 10.3969/j.issn.1004-0412.2016.12.029.
34 陈家颖, 刘荣添, 刘丽辉, 等. 不同脐带结扎方式对早产儿的影响[J]. 医学信息, 2021, 34(7): 106-109. DOI: 10.3969/j.issn.1006-1959.2021.07.029.
35 张润菊, 蒙引娟. 延迟脐带结扎与脐带挤压对早产儿血容量、血红蛋白和胆红素水平的影响[J]. 宁夏医学杂志, 2021, 43(3): 235-238. DOI: 10.13621/j.1001-5949.2021.03.0235.
36 陈惠金, 魏克伦, 姚裕家, 等. 我国早产儿脑室周围白质软化发生率的多中心调查报告[J]. 中国当代儿科杂志, 2008, 10(6): 686-692. PMID: 19102830.
37 曹琳琳, 魏媛, 卢倪, 等. 挤压脐带与延迟断脐对早产儿临床效果比较的Meta分析[J]. 中国护理管理, 2020, 20(1): 78-84. DOI: 10.3969/j.issn.1672-1756.2020.01.017.
38 张莉, 黄绮薇, 龚小慧, 等. 脐带挤压对早产儿血红蛋白量、胆红素及心功能的早期影响[J]. 上海交通大学学报(医学版), 2018, 38(10): 1197-1202. DOI: 10.3969/j.issn.1674-8115.2018.10.011.
基金
南京市卫生科技发展专项资金项目（YKK21162）；江苏省高校优势学科建设工程项目“护理学”（苏政办发〔2018〕87号）。
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