Umbilical cord clamping in the early phases of the COVID-19 era - a systematic review and meta-analysis of reported practice and recommendations in guidelines

Johan Henrik Martin Berg; Li Thies-Lagergren; Jenny Svedenkrans; Jeremiah Samkutty; Sara Marie Larsson; Judith S Mercer; Heike Rabe; Ola Andersson; Mehreen Zaigham

doi:10.1016/j.ijid.2023.10.010

Umbilical cord clamping in the early phases of the COVID-19 era - a systematic review and meta-analysis of reported practice and recommendations in guidelines

Int J Infect Dis. 2023 Dec:137:63-70. doi: 10.1016/j.ijid.2023.10.010. Epub 2023 Oct 13.

Authors

Johan Henrik Martin Berg¹, Li Thies-Lagergren², Jenny Svedenkrans³, Jeremiah Samkutty⁴, Sara Marie Larsson⁵, Judith S Mercer⁶, Heike Rabe⁴, Ola Andersson⁷, Mehreen Zaigham⁸

Affiliations

¹ Department of Clinical Sciences Lund, Pediatrics, Lund University, Lund, Sweden; Department of Neonatology, Skåne University Hospital, Lund, Sweden. Electronic address: johan.berg@med.lu.se.
² Department of Health Sciences, Midwifery Research - Reproductive, Perinatal, and Sexual Health, Lund University, Lund, Sweden.
³ Department of Clinical Sciences Lund, Pediatrics, Lund University, Lund, Sweden; Department of Neonatology, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden.
⁴ Academic Department of Paediatrics, Brighton and Sussex Medical School, University of Sussex, Brighton, UK.
⁵ Department of Clinical Sciences Lund, Pediatrics, Lund University, Lund, Sweden; Department of Clinical Chemistry, Hospital of Halland, Varberg/Halmstad, Sweden.
⁶ Neonatal Research Institute, Sharp Mary Birch Hospital for Women and Newborns, San Diego, USA.
⁷ Department of Clinical Sciences Lund, Pediatrics, Lund University, Lund, Sweden; Department of Neonatology, Skåne University Hospital, Lund, Sweden.
⁸ Department of Clinical Sciences Lund, Obstetrics and Gynecology, Lund University, Lund, Sweden.

PMID: 37839504
DOI: 10.1016/j.ijid.2023.10.010

Abstract

Objectives: At the beginning of the COVID-19 pandemic, delayed umbilical cord clamping (CC) at birth may have been commonly discouraged despite a lack of convincing evidence of mother-to-neonate SARS-CoV-2 transmission. We aimed to systematically review guidelines, and reports of practice and to analyze associations between timing of CC and mother-to-neonate SARS-CoV-2 transmission during the early phases of the pandemic.

Methods: Major databases were searched from December 1, 2019, to July 20, 2021.

Inclusion: studies and guidelines describing CC practice in women with SARS-CoV-2 infection during pregnancy until 2 postnatal days, giving birth to live-born neonates.

Exclusion: no extractable data. Two reviewers independently screened studies for eligibility and assessed study quality. Pooled prevalence rates were calculated.

Results: Forty-eight studies (1476 neonates) and 40 guidelines were included. Delayed CC was recommended in 70.0% of the guidelines. Nevertheless, delayed CC was reported less often than early CC: 262/1476 (17.8%) vs 511/1476 (34.6%). Neonatal SARS-CoV-2 positivity rates were similar following delayed (1.2%) and early CC (1.3%). Most SARS-CoV-2 transmissions (93.3%) occurred in utero.

Conclusion: Delayed CC did not seem to increase mother-to-neonate SARS-CoV-2 transmission. Due to its benefits, it should be encouraged even in births where the mother has a SARS-CoV-2 infection.

Systematic review registration: Prospero CRD42020199500.

Keywords: COVID-19/transmission*; Delivery; Newborn; SARS-CoV-2; Umbilical cord; Umbilical cord clamping.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

COVID-19* / epidemiology
COVID-19* / prevention & control
Female
Humans
Infant, Newborn
Infectious Disease Transmission, Vertical / prevention & control
Pandemics
Pregnancy
Pregnancy Complications, Infectious* / epidemiology
Pregnancy Complications, Infectious* / prevention & control
SARS-CoV-2
Umbilical Cord Clamping