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Am J Perinatol 2025; 42(16): 2077-2086
DOI: 10.1055/a-2598-7291
Review Article

Comparing Umbilical Cord Management Strategies in Nonvigorous Newborns: A Systematic Review and Network Meta-analysis

Authors

  • Mohamed A. Aldemerdash    #

    1   Faculty of Medicine, Sohag University, Sohag, Egypt
    2   Medical Research Group of Egypt, Negida Academy, Arlington, Massachusetts

  • Mohammed Abdellatif    #

    2   Medical Research Group of Egypt, Negida Academy, Arlington, Massachusetts
    3   Pediatrics and Neonatology Specialist, Muscat Private Hospital, Muscat, Oman

  • Doha Refaey

    1   Faculty of Medicine, Sohag University, Sohag, Egypt
    2   Medical Research Group of Egypt, Negida Academy, Arlington, Massachusetts

  • Yaser AbuSammour 

    2   Medical Research Group of Egypt, Negida Academy, Arlington, Massachusetts
    4   Faculty of Medicine, Al-Balqa Applied University, Al-salt, Jordan

  • Mahmoud Refaey

    1   Faculty of Medicine, Sohag University, Sohag, Egypt
    2   Medical Research Group of Egypt, Negida Academy, Arlington, Massachusetts

  • Abdelrhman Muwafaq Janem 

    2   Medical Research Group of Egypt, Negida Academy, Arlington, Massachusetts
    5   Faculty of Medicine, Al Quds University, Jerusalem, Palestine

  • Mohammed Tarek Hasan 

    2   Medical Research Group of Egypt, Negida Academy, Arlington, Massachusetts
    6   Faculty of Medicine, Al-Azhar University, Cairo, Egypt

  • Ahmed Aldemerdash 

    1   Faculty of Medicine, Sohag University, Sohag, Egypt
    2   Medical Research Group of Egypt, Negida Academy, Arlington, Massachusetts

  • Huda Shihab

    2   Medical Research Group of Egypt, Negida Academy, Arlington, Massachusetts
    7   Faculty of Medicine, Omar Almokhtar University, Albayda, Libya

  • Naema Hamouda 

    2   Medical Research Group of Egypt, Negida Academy, Arlington, Massachusetts
    8   El-Sahel Teaching Hospital, General Organisation for Teaching Hospitals and Institutes, Cairo, Egypt

Funding None.
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Abstract

Nonvigorous newborns often require immediate resuscitation, and early cord clamping (ECC) is the conventional approach. Alternative strategies, such as intact cord resuscitation (ICR) and umbilical cord milking (UCM), may provide additional benefits without compromising safety. To compare the effectiveness and safety of different umbilical cord management strategies for nonvigorous newborns. We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines and searched six databases for randomized controlled trials comparing different umbilical cord management approaches in nonvigorous newborns. Outcomes assessed included resuscitation effectiveness, hematological parameters, neonatal morbidities, and mortality. The Cochrane Collaboration tool RoB2 was used to assess the risk of bias. Ten studies with 2,541 newborns were included, with seven studies contributing to the meta-analysis. No significant differences were observed in resuscitation requirements, Apgar scores, or mortality between ECC, ICR, and UCM. However, at 5 minutes, ICR showed a small but statistically significant higher Apgar score compared with other interventions (mean difference [MD] = 0.3, 95% confidence interval [CI] [0.05, 0.55]). Additionally, heart rate was lower in the intact ICM (I-UCM) group (MD = −34.75 beats/min, 95% CI [−61.84, −7.66]). Cut UCM was associated with significantly higher serum ferritin levels at 6 weeks (MD = 40.44 µg/L, 95% CI [26.45, 54.43]). Initial hematocrit levels were also higher in the ICR group compared with ECC. ICR and UCM might be safe and effective alternatives to ECC for nonvigorous newborns, with potential hematological benefits. However, further large-scale studies are needed to confirm these findings and evaluate long-term neurodevelopmental outcomes.

Key Points

  • ICR and UCM might be safe and effective alternatives to ECC for nonvigorous newborns.

  • Heart rate was lower in the I-UCM group.

  • ICR showed statistically significant higher Apgar.

  • Cut UCM was associated with significantly higher serum ferritin levels at 6 weeks.

Keywords

nonvigorous newborns - umbilical cord management - intact cord resuscitation - umbilical cord milking - early cord clamping

Authors' Contributions

N.H.: conceptualization, writing—reviewing and editing. M.A.A.: project administration, writing—reviewing and editing. D.R., A.A., A.M.J., M.R. was involved in data curation and writing—original draft; participated in screening, tables, and figures. M.T.H.: formal analysis and software. Y.A.S. and H.S. were involved in methodology and writing—original draft. supervision and writing—reviewing and editing by M.A.


# Authors equally contributed to the manuscript and deserved co-first authorship.


Supplementary Material



Publication History

Received: 09 January 2025

Accepted: 01 May 2025

Accepted Manuscript online:
02 May 2025

Article published online:
23 May 2025

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