Individual participant data on COrd Management at Preterm birth (iCOMP)
The Problem
Each year, 15 million babies are born preterm (i.e. too early). Of these, 1.1 million die, and surviving children have an increased risk of developmental difficulties and chronic ill health. At birth, the baby moves from the foetal to the neonatal circulation. For babies born too soon, allowing longer for this physiological transition by deferring cord clamping may be beneficial. Concerns about deferring cord clamping include delayed respiratory support.
This uncertainty about the optimal strategy for cord management at preterm birth has led to many recent trials that compare alternative policies. Such policies include immediate cord clamping and short (30 seconds), medium (45 seconds) or long deferrals (up to 5 minutes) in clamping, ‘milking’ the cord before or after clamping, or physiology-based clamping (e.g. clamping after spontaneous breathing).
What Have We Found?
The first round of results have in November 2023 been published in The Lancet as two companion articles. The pairwise analysis showed us high-certainty evidence that deferred cord clamping reduces death before discharge in preterm infants when compared with immediate cord clamping, while the network meta-analysis showed how long deferral of cord clamping reduces odd of death before discharge in preterm infants.
The two publications can be found here:
iCOMP aims
The iCOMP Collaboration aims to use data from all relevant trials (currently 118 planned, ongoing or completed trials including more than 15,000 babies) to evaluate the comparative effects of cord management strategies such as milking or delayed cord clamping on neonatal mortality and morbidity.
We will also investigate the impact of alternative cord management strategies for different key subgroups of infants, such as those requiring resuscitation at birth or born very early (before 32 weeks gestation).
New Methods?
The value of currently planned and recently completed trials can be substantially enhanced by combining and fully utilising the individual participant data of these trials. We therefore propose a world-first individual participant data network meta-analysis. Network meta-analysis methods enable comparison and ranking of these multiple treatment options by enabling a combination of direct and indirect comparisons of these options. Using individual participant data enables exploration of subgroups to give differential cord management recommendations for different groups of participants, and may improve the consistency of the network meta-analysis.
For more information on the iCOMP Study and the methodology, please read the protocol available on BMJ Open.