(Open access funding provided by Semmelweis University)
Evidence supporting the benefits of delayed cord clamping is increasing; however,
there is no clear recommendation on cord management during newborn resuscitation.
This study aimed to investigate the effects of resuscitation initiated with an intact
umbilical cord, hypothesizing it is a safe stabilization procedure that improves neonatal
outcomes.Systematic search was conducted in MEDLINE, Embase, CENTRAL, and Web of Science
from inception to March 1, 2024. Eligible articles compared neonatal outcomes in newborns
receiving initial stabilization steps before and after cord clamping.Twelve studies
met our inclusion criteria, with six RCTs included in the quantitative analysis. No
statistically significant differences were found in delivery room parameters, in-hospital
mortality, or neonatal outcomes between the examined groups. However, intact cord
resuscitation group showed higher SpO2 at 5 min after birth compared to cord clamping
prior to resuscitation group (MD 6.67%, 95% CI [-1.16%, 14.50%]). There were no significant
differences in early complications of prematurity (NEC ≥ stage 2: RR 2.05, 95% CI
[0.34, 12.30], IVH: RR 1.25, 95% CI [0.77, 2.00]).Intact cord management during resuscitation
appears to be a safe intervention; its effect on early complications of prematurity
remains unclear. Further high-quality RCTs with larger patient numbers are urgently
needed.Initiating resuscitation with an intact umbilical cord appears to be a safe
intervention for newborns. No statistically significant differences were found in
delivery room parameters, in-hospital mortality, and neonatal outcomes between the
examined groups. The utilization of specialized resuscitation trolleys appears to
be promising to reduce the risk of intraventricular hemorrhage in preterm infants.
Further high-quality RCTs with larger sample sizes are urgently needed to refine recommendations.
