不同脐带处理策略对新生儿临床结局及检验指标的影响

Clinical Laboratory Tests and Neonatal Clinical Outcomes Using Different Strategies of Umbilical Cord Management:A Systematic Review

目的:系统评价不同脐带处理策略对新生儿临床结局及检验指标的影响。方法:计算机检索国内外有关立即断脐(ICC)、延迟断脐(DCC)、脐带挤压(UCM)对新生儿结局影响的临床随机对照试验。严格质量评价后,采用R语言软件进行分析。结果:最终纳入22篇文献共4395例。结果表明,DCC与ICC相比可以提高早产儿出生后血细胞比容(MD 5.6,95%CI 1.97~9.24,P<0.01),可以提高足月儿出生后红细胞比容(MD 2.7,95%CI 0.55~4.86,P=0.01)和血清铁蛋白浓度(MD 17.16,95%CI 1.03~33.29,P=0.04),降低早产儿死亡率(RR 0.69,95%CI 0.49~0.97,P=0.03),脑室内出血(RR 0.57,95%CI 0.34~0.93,P=0.03)和败血症发生率(RR 0.46,95%CI 0.25~0.85,P=0.01),且不提高坏死性小肠炎(RR 0.52,95%CI 0.17~1.65,P>0.05)和早产儿视网膜病的发生率(RR 0.92,95%CI 0.37~2.25,P>0.05)。DCC与UCM相比,早产儿出生后慢性肺部疾病、死亡率、脑室内出血、坏死性小肠炎和败血症的发生率差异无统计学意义(P>0.05),对足月儿而言,DCC可以提高出生后血清铁蛋白浓度(MD 12.72,95%CI 10.47~14.98,P<0.01)。UCM与ICC相比,可以提高早产儿血红蛋白水平(MD 1.73,95%CI 0.62~2.84,P<0.01),早产儿出生后死亡率、脑室内出血、败血症、坏死性小肠炎和高钾血症的发生率差异无统计学意义(P>0.05)。结论:与ICC相比,DCC和UCM可能有益于改善新生儿的近期临床结局。

Objective:To systematically evaluate the performances of different umbilical cord management strategies in clinical laboratory tests and clinical outcomes of newborns.Methods:We searched the clinical randomized controlled trials with search terms‘immediate cord clamping’,‘delayed cord clamping’,and‘umbilical cord miking’.R software was used for statistic analysis.Results:A total of 22 RCTs invoving 4395 patients were included.Meta-analysis results showed that compared with immediate cord clamping,delayed cord clamping could improve the postnatal hematocrit of premature infants(MD 5.6,95%CI 1.97-9.24,P<0.01),reduce the incidence of death(RR 0.69,95%CI 0.49-0.97,P=0.03),intraventricular hemorrhage(RR 0.57,95%CI 0.34-0.93,P=0.03)and sepsis(RR 0.46,95%CI 0.25-0.85,P=0.01).Incidence of necrotizing enterocolitis(RR 0.52,95%CI 0.17-1.65,P>0.05)and retinopathy were not increased(RR 0.92,95%CI 0.37-2.25,P>0.05).The term group also increased the hematocrit(MD 2.7,95%CI 0.55-4.86,P=0.01)and serum ferritin level after birth(MD 17.16,95%CI 1.03-33.29,P=0.04).There was no significant difference in the incidence of chronic lung disease,mortality,intraventricular hemorrhage,necrotizing enterocolitis and sepsis between delayed cord clamping and umbilical cord miking in premature infants(P>0.05).For term infants,delayed cord clamping could increase the level of serum ferritin after birth(MD 12.72,95%CI 10.47-14.98,P<0.01).Compared with immediate cord clamping,umbilical cord miking could increase the hemoglobin level of premature infants(MD 1.73,95%CI 0.62-2.84,P<0.01),and the incidence of death,intraventricular hemorrhage,sepsis,necrotizing enterocolitis,and hyperkalemia were no significant difference in premature infants(P>0.05).Conclusions:Compared with immediate cord clamping,delayed cord clamping and umbilical cord miking might improve the short-term newborns'outcomes.