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

Persad, Emma ; Sibrecht, Greta ; Ringsten, Martin LU ; Karlelid, Simon LU ; Romantsik, Olga LU ; Ulinder, Tommy LU ; Do Nascimento, Israel Junior Borges ; Bjorklund, Maria LU ; Arno, Anneliese and Bruschettini, Matteo LU (2021) In PLoS ONE 16(2 February).
Abstract

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... (More)

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.

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PLoS ONE
volume
16
issue
2 February
article number
e0246353
publisher
Public Library of Science
external identifiers
  • scopus:85101008163
  • pmid:33556082
ISSN
1932-6203
DOI
10.1371/journal.pone.0246353
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English
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yes
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018d86e9-162a-4471-8fe4-421757cd6ebb
date added to LUP
2021-03-04 10:57:01
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2021-06-08 01:57:44
@article{018d86e9-162a-4471-8fe4-421757cd6ebb,
  abstract     = {<p>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.</p>},
  author       = {Persad, Emma and Sibrecht, Greta and Ringsten, Martin and Karlelid, Simon and Romantsik, Olga and Ulinder, Tommy and Do Nascimento, Israel Junior Borges and Bjorklund, Maria and Arno, Anneliese and Bruschettini, Matteo},
  issn         = {1932-6203},
  language     = {eng},
  number       = {2 February},
  publisher    = {Public Library of Science},
  series       = {PLoS ONE},
  title        = {Interventions to minimize blood loss in very preterm infants-A systematic review and meta-analysis},
  url          = {http://dx.doi.org/10.1371/journal.pone.0246353},
  doi          = {10.1371/journal.pone.0246353},
  volume       = {16},
  year         = {2021},
}