185 - Umbilical cord clamping practice recommendations in mothers with suspected or confirmed Coronavirus 19 disease – A systematic review of guidelines.

Poster Number: 185
Publication Number: 185.234

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 recommended by the World Health Organization (WHO). Delayed CC decrease mortality in preterm neonates, increase iron stores in infancy and improve neurodevelopment up to four years of life in term newborns.
However, concerns that the Coronavirus Disease 2019 (COVID-19) in pregnant women may have negative impact on neonatal outcome at birth through maternal compromise or vertical infection. This may have affected the CC recommendations in official guidelines.

Objective: The primary objective: To systematically examine guidelines for recommendations on cord management after birth in mothers with suspected or confirmed COVID-19.
Secondary objectives: to analyze if recommendations have changed with time during the pandemic and geographical differences in CC recommendations.

Design/Methods: Medline, Embase, Cochrane database, Google Scholar, Web of Science, PubMed, EuropePCM pre-prints, NLM LitCovid, TRIP database, along with reference lists were systematically searched from December 1st 2019 to July 20th 2021 for guidelines reporting on cord management after birth in mothers with suspected or confirmed COVID-19. Only the latest version of the guideline was included. Two researchers independently reviewed the results.
Binary logistic regression was used to examine whether date of guideline publication was associated with delayed CC recommendation. Previous versions of the same guidelines were included in this model (Figure 1).

Results: The search strategy identified 3222 results and 41 guidelines from different bodies were included in the final analysis (figure 1). Overall, CC recommendations were: Delayed CC 27 (66%), early CC 14 (34%).
Guidelines from the WHO Western Pacific Region had the highest proportion of early CC recommendations (Figure 2).
The most stated reasons for delayed CC recommendation was no current evidence of association with vertical COVID-19 transmission or adverse neonatal outcome. The main reason against delayed CC recommendation were unknown risk of vertical perinatal infection.
Guidelines published more recently were more likely to recommend delayed CC, OR 1.828
(1.024-3.262), p=0.04.Conclusion(s): A growing body of data has demonstrated that delayed CC is safe in mothers with COVID-19. Two thirds of the guidelines recommended delayed CC in mothers with suspected or confirmed COVID-19. The most common justification for early CC was lack of evidence of vertical mother-infant transmission. As the pandemic has evolved, a larger proportion of guidelines tended to be in favor of delayed CC.
Curriculum Vitae_ Johan BergForsknings-CV + publ lista Johan B English erg .pdf
Geographical comparison of umbilical cord clamping practice recommendations in mothers with suspected or confirmed COVID-19Guideline distribution by World Health Organization Region