27 - Titel: Umbilical cord clamping practice and vertical mother-newborn transmission during the COVID-19 pandemic – A systematic review.

Poster Number: 27
Publication Number: 27.338

Johan Berg, Lund University, Malmo, Skane Lan, Sweden; Li Thies-Lagergren, Lund University, Förslöv, Skane Lan, Sweden; Jenny Svedenkrans, Lund University and Karolinska Institutet, Lund, Skane Lan, Sweden; Jeremiah Samkutty, Brighton and Sussex Medical School, Brighton, England, United Kingdom; Marie Larsson, Lund University, Lund, Skane Lan, Sweden; Judith S. Mercer, Sharp Mary Birch Hospital Neonatal Research Institute, Marion, MA, United States; Heike Rabe, Brighton and Sussex Medical School, Brighton, England, United Kingdom; Ola Andersson, Lund University, Halmstad, Hallands Lan, Sweden

Background: Delayed umbilical cord clamping (CC) is widely practiced globally and has been associated with lower neonatal mortality, higher iron levels in infancy and better neurodevelopment up to four years of life.
Early in the Coronavirus Disease 2019 (COVID-19) pandemic, protocols for cord management following birth tended either not to mention CC practice or to recommend early CC, the latter mostly due to concerns of vertical mother-newborn transmission.

Objective: To systematically examine:
Primary objective.
How cord clamping practice has been reported in the literature during the COVID-19 pandemic.
Secondary objectives.
a. Associations between cord clamping practice and vertical mother-infant COVID-19 transmission.
b. Geographical differences in cord clamping practice.

Design/Methods: Medline, Embase, Cochrane database, Google Scholar, Web of Science, PubMed, EuropePCM pre-prints, NLM LitCovid and TRIP database were systematically searched from December 1, 2019 to July 20, 2021 for case reports, case series and cohort studies reporting on cord management and vertical COVID-19 mother-infant transmission.
Two researchers independently reviewed the studies. The search strategy identified 3192 studies, where of 320 duplicates. Another 2232 studies were excluded based on the abstract and 559 studies based on the full text.

Results: Fifty studies were included; 31 case reports, 3 case series, 7 prospective cohorts and 9 retrospective cohorts. In total, 1980 newborns were included. The distribution of CC practice in the infants were: Delayed CC 472 (23.8%), early CC 805 (40.7%), CC practice not reported 703 (35.5%). Vertical transmission was reported in 76 (3.8%) cases: Delayed CC 5, early CC 23, CC practice not reported 48. Transmission rates between groups were: Delayed CC 5/472 (1%), early CC 23/805 (2.9%) (Table 1).
Most studies (84 %) were conducted in high- or upper middle-income countries. The majority of studies (93.8%) from the World Health Organization (WHO) Western Pacific and Eastern Mediterranean Region reported early CC (Table 2).Conclusion(s): Early CC was reported almost twice as often as delayed CC in studies conducted during the COVID-19 pandemic and was particularly common in the WHO Western Pacific and Eastern Mediterranean Region. The rate of reported cases of vertical transmission did not differ following early and delayed CC. The high early CC levels may reflect a scientifically unjustified risk perception of vertical COVID-19 transmission following delayed CC with potential harmful short and long-term consequences for the child.
Curriculum Vitae_ Johan BergForsknings-CV + publ lista Johan B English erg .pdf
Table 2Cord clamping practice: delayed, early or a mixture between delayed and early (CC) reported in studies by World Health Organization Region