Umbilical cord management in extremely preterm infants born by cesarean delivery
Notice bibliographique
Résumé
BACKGROUND: Deferred cord clamping reduces mortality in preterm infants. However, there is a controversy about whether deferred cord clamping is as effective in cesarean delivery as in vaginal delivery. OBJECTIVE: This study aimed to compare the mortality and short-term outcomes of extremely preterm singleton infants who received deferred cord clamping after cesarean delivery with those who received deferred cord clamping after vaginal delivery and those who received early cord clamping after cesarean delivery. STUDY DESIGN: A national retrospective review of maternal, perinatal, and neonatal data of preterm infants born at <29 weeks of gestation who were admitted to units participating in the Canadian Neonatal Network between January 2015 and December 2022 was conducted. The rates and trends of deferred cord clamping (≥ 30 seconds) were evaluated, and the outcomes of infants who received deferred cord clamping after cesarean delivery were compared with (a) those who received deferred cord clamping after vaginal delivery and (b) those who received early cord clamping (<30 seconds) after caesarean delivery. The primary outcome was hospital mortality/severe brain injury (defined as grade 3/4 intraventricular hemorrhage and/or periventricular leukomalacia). Multivariate regression models with generalized estimating equations were used to account for clustering of infants within each site after adjusting for potential confounders. RESULTS: Of 6137 infants included in the study, 1952 (31.8%) received deferred cord clamping after cesarean delivery, 1804 (29.4%) received deferred cord clamping after vaginal delivery, and 2381 (38.8%) received early cord clamping after cesarean delivery at a median gestational age of 27 (interquartile range, 25-28), 26 (interquartile range, 25-28) and 26 (interquartile range, 25-28) weeks, respectively. There was a slow increase in the practice of deferred cord clamping in cesarean delivery from 32% in 2015 to approximately 50% in 2021-2022. After adjustment for potential confounders, infants who received deferred cord clamping after cesarean delivery had lower odds of a composite of mortality/severe brain injury (281/1952 [14%]) than those who received deferred cord clamping after vaginal delivery (347/1804 [19%]; adjusted odds ratio, 0.69 [95% confidence interval, 0.54-0.87]) and those who received early cord clamping after cesarean delivery (543/2381 [23%]; adjusted odds ratio, 0.69 [95% confidence interval, 0.57-0.83]). Deferred cord clamping after cesarean delivery was not associated with changes in other adverse short-term outcomes. CONCLUSION: Deferred cord clamping was associated with a reduction in a composite of mortality/severe brain injury in singleton preterm infants born at <29 weeks of gestation via cesarean delivery.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».