143 A comparison of the different strategies for managing the umbilical cord at birth
Bibliographic record
Abstract
Delayed cord clamping (DCC) at birth for at least 30 seconds has been recommended as the standard of care for preterm infants. However, other strategies like umbilical cord milking (UCM) and early cord clamping (ECC) are still being practiced. To investigate the frequency and trend of practicing different strategies for managing the umbilical cord at birth (ECC, UCM, and DCC) in preterm infants and to compare the short-term outcomes of these strategies. We conducted a retrospective review of maternal, perinatal and neonatal data of preterm infants born at <33 weeks’ gestation who were admitted to NICUs participating in the Canadian Neonatal Network Database between January 2015 and December 2017. Infants planned for palliative care and those with major congenital anomalies were excluded. Patients who received ECC (<30 seconds), UCM or DCC (≥ 30 seconds) were compared. Multiple logistic regression model with generalized estimation equation (GEE) approach was used to compare the outcomes among the three strategies adjusted for confounders. Of 12749 patients admitted during the three-year study period, 9729 infants were included. 4916 (50.5%) received ECC, 394 (4.1%) received UCM and 4419 (45.4%) received DCC. The trend of practicing UCM and DCC has increased over study years (p<0.001)-Figure 1. Maternal and neonatal characteristics are shown in Table 1. After adjustment for potential confounders identified as significantly different between groups on univariate analysis, patients who received DCC had higher birth weight and lower odds of Apgar score <4 at 5 minutes, surfactant administration, inotropic support in first 48hrs, receiving blood transfusions, intraventricular hemorrhage, sepsis, patent ductus arteriosus, and mortality than those who received ECC (Table 2). DCC patients had also lower odds of intubations, surfactant use and severe IVH than those who received UCM. On the other hand, UCM patients had higher admission temperature than the ECC and DCC groups. Neither DCC nor UCM was associated with any adverse effects when compared to ECC. The practice of DCC and UCM for preterm infants has increased over the last three years in Canadian NICUs. However, 44% of patients still received ECC in 2017.This study confirms the significant beneficial effects of DCC on the short-term outcomes in preterm infants.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.008 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".