Original Title: [Avnavling vid en minut, vilket möjliggör stamcellsskörd, jämfört med senare avnavling – utfall för moder och barn]

Authors' objectives: Background At the time of birth, the infant is attached to the placenta through the umbilical cord, which is then clamped and cut. The timing of this in healthy newborns varies, but recent guidelines often recommend delayed >1 minutes (min) cord clamping. This may be beneficial for the infant, reducing the risk of anaemia and iron deficiency. By contrast, early compared with delayed cord clamping improves the possibility to obtain umbilical cord blood allowing harvest of stem cells. After cord clamping, umbilical blood is collected, and made available for treatment of different conditions through international registries. Haematopoietic stem cell transplantation is used to treat severe hereditary and malignant diseases. Question at issue Effects of umbilical cord clamping at 1 min compared with clamping at >1 min in newborn infants and healthy mothers with term pregnancy (≥37+0), concerning infant and maternal morbidity?

Authors' results and conclusions: Conclusion Regarding outcomes critical for decision making there was only inconclusive data for maternal postpartum haemorrhage >1,000 ml, and no data on the other critical outcomes, neither for newborn infants nor for mothers with term pregnancy, comparing cord clamping at 1 min with clamping at >1 min. For important infant outcomes, with moderate certainty of evidence, significant differences were seen for infant immediate haematocrit, with a mean difference of -3.09 (95%CI: -3.87 to -2.30) pp., p<0.00001, and short-term haemoglobin with a mean difference of -1.36 g/dl (95%CI: -1.48 to -1.24), p<0.00001, both (<10% differences between the groups) in favour for clamping at >1 min. Early umbilical cord clamping (here defined as at 1 min), versus delayed clamping (here defined as > 1 min) allows collection of umbilical cord blood improving the possibility of stem cell harvesting. In summary, although current evidence regarding important infant outcomes does not suggest major infant or maternal risks, important knowledge gaps for critical outcomes preclude definitive conclusions regarding the safety of umbilical cord clamping at 1 min.

Authors' methods: After definition of PICO, systematic literature searches in Medline, Embase, the Cochrane Library and Cinahl were conducted. Two authors screened the obtained abstracts and made a first selection of full-text reports. All authors read these full-text reports and decided in consensus which reports should be included. Included studies were critically appraised using checklists. The results of each study were summarised per outcome and when possible, data were pooled in a meta-analysis. The certainty of evidence for each outcome was assessed using the GRADE approach. Summary of the results per outcome and the associated certainties of evidence were presented in a Summary-of-findings table.

Project Status: Completed

Year Published: 2024

URL for published report: https://mellanarkiv-offentlig.vgregion.se/alfresco/s/archive/stream/public/v1/source/available/sofia/su4372-2081313122-152/native/2024%20_140%20HTA-rapport%20Umbilical%20Cord%20Clamping%20%202024-12-19.pdf

English language abstract: An English language summary is available

Publication Type: Full HTA

Organisation Name: The Regional Health Technology Assessment Centre

Contact Address: The Regional Health Technology Assessment Centre, Region Vastra Gotaland, HTA-centrum, Roda Straket 8, Sahlgrenska Universitetssjukhuset, 413 45 GOTHENBORG, Sweden

Contact Name: hta-centrum@vgregion.se

Contact Email: hta-centrum@vgregion.se