Oral or Poster Presentation
Concurrent Session 4D - Maternal Fetal Medicine
Introduction: Deferred cord clamping (DCC) saves lives. It reduces extremely preterm infants’ mortality by 30%, but only a minority of such infants receive it. Our objective was to systematically review guidelines on cord management to identify consensus and variation in guidance and to appraise guideline quality.
Methods: We searched 10 medical and guideline databases from January 1, 2010 to July 17, 2019. Guideline recommendations, sources of evidence and whether guidelines reported the mortality related benefit of DCC in preterm infants was extracted (as clinicians are most likely to change practice based on evidence showing beneficial outcomes like decreased mortality). We appraised guideline quality with modified Appraisal of Guidelines for REsearch & Evaluation II (AGREE II) and AGREE-Recommendation EXcellence (AGREE-REX) tools.
Results: We found 52 recommendations from 43 national and international clinical practice guidelines, position statements and consensus statements (collectively, “Statements” hereafter). Forty recommendations specified an optimal duration for DCC with the most common being at least 60 seconds, but including: at least 30 seconds, less than 60 seconds, 30-120 seconds, 30-180 seconds, until cord pulsations cease, until the placenta delivers, or up to 5 minutes. Fifteen recommendations were supported by evidence from randomized controlled trials or meta-analyses. Three out of 37 Statements recommending DCC for preterm or preterm/term infants cited a mortality benefit for DCC use (with meta-analyses evidence). Roughly two thirds of Statements were considered high quality in the clarity of presentation domain of the AGREE II tool. However, more than three fourths were considered moderate/low quality recommendations for being clinically credible and implementable according to the AGREE-REX tool.
Conclusion: Worldwide, only 15 out of 40 recommendations specifying DCC duration were concordant with randomized controlled trial evidence and only 3 Statements cited a preterm mortality benefit for DCC use. While many Statements had clear recommendations, credibility and implementability would benefit from improvement.