Thesis (MCurr)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Intraventricular haemorrhage is associated with neurological morbidity
and mortality in low birth weight infants. In spite of improvements in
treatment to reduce the incidence of the haemorrhage, the condition
continues to remain a major cause of long term morbidity in low birth
weight infants. The evidence from the literature has shown that low
birth weight infants might benefit from delayed cord clamping
particularly in reducing the risk of intraventricular haemorrhage and its
neurological consequences.
The primary objective of this review was to assess the effects of
delayed versus early cord clamping on intraventricular haemorrhage
amongst low birth weight infants. The secondary objectives were to
evaluate the effects of delayed versus early cord clamping on the
Apgar scores, hyperbilirubinaemia and polycythaemia in infants.
The following electronic databases were searched: CINAHL, MEDLINE
(searched via PubMed) and Cochrane Central Register of Controlled
Trials (CENTRAL). Other information was gathered from the reference
lists of retrieved articles and relevant experts. The selection criteria
entailed all randomised controlled trials comparing delayed versus
early cord clamping following birth in infants with low birth weight. Two
reviewers independently extracted the data and assessed the quality of
the trials. Disagreements on studies for inclusion were resolved by
discussion with the third reviewer.
The review included five randomised controlled trials with 215
participants. The risk of intraventricular haemorrhage was significantly
reduced in the delayed compared with early cord clamping (RR0.52,
95% CI 0.33 to 0.82, P=0.005). No statistically significant difference
was shown between delayed versus early cord clamping for the risk of
hyperbilirubinaemia (RR O.48, 95% CI -0.43 to 1.39, P=0.30). There was no data available for other comparisons: Polycythaemia and Apgar
scores.
There is growing evidence that delayed cord clamping might benefit
low birth weight infants. In the included studies, delayed cord clamping
for at least 30 seconds appear to have a potential in reducing the risk
of intraventricular haemorrhage. The results of this review should
however be interpreted with caution due to a limited number of studies
with the absence of clinically important secondary outcomes in the
included trials. Further research is required on large scale randomised
controlled trials. / AFRIKAANSE OPSOMMING: Intraventrikulêre bloeding word geassosieer met neurologiese
morbiditeit en mortaliteit in suigelinge met ’n lae geboortegewig. Ten
spyte van die verbetering in die behandeling om die gevalle van
bloeding te verminder, duur die toestand voort as ’n belangrike oorsaak
van langtermyn morbiditeit in lae gewig geboortes. Bewyse uit die
literatuur toon dat suigelinge met ’n lae geboortegewig voordeel mag
trek uit vertraagde afklemming, veral deur die vermindering van die
risiko van intraventrikulêre bloeding en die neurologiese gevolge
daarvan.
Die primêre doelwit van hierdie navorsing was om die effek van
vertraagde, versus vroeë afklemming op intraventrikulêre bloeding
onder suigelinge met ’n lae geboortegewig te bepaal. Die sekondêre
doelwit is om die effekte van vertraagde, versus vroeë afklemming op
die Apgar uitslae, hiperbilirubinaemia en polisitaemia by suigelinge te
evalueer.
Die volgende elektroniese databasisse is nagegaan: CINAHL,
MEDLINE (soektog via PubMed); Cochrane Central Register of
Controlled Trials (CENTRAL). Ander inligting is verkry uit die
bronnelyste van nagevorsde artikels en van relevante deskundiges.
Die seleksie kriteria behels alle ewekansige beheerde toetsing,
insluitende toekomstige studies wat vertraagde, versus vroeë
afklemming vergelyk by suigelinge met ’n lae geboortegewig. Twee
resensente het onafhanklik data geneem en die kwalititeit van die
toetse bepaal. Verskille oor insluiting van navorsing, is met ’n derde
resensent deur middel van bespreking opgelos.
Die navorsing het vyf ewekansige beheerde steekproewe met 215
deelnemers ingesluit. Die risiko van intraventrikulêre bloeding is
beduidend verminder in die vertraagde gevalle, in teenstelling met
vroeë afklemming (RR0.52, 95% CI 0.33 tot 0.82, P=0.005). Geen statistiese beduidende verskil is bewys tussen vertraagde teenoor
vroeë afklemming ten opsigte van hiperbilirubinaemia nie (RR 0.48,
95% CI – 0.43 tot 1.39, P=0.30). Daar was geen data beskikbaar vir
ander vergelykings nie: Polisytaemia en Apgar uitslae.
Daar is groeiende bewyse dat vertraagde afklemming lae
geboortegewig suigelinge mag beïnvloed. Dit wil in die ingeslote
studies voor kom dat vertraagde afklemming van ten minste 30
sekondes die potensiaal het om die risiko van intraventrikulêre
bloeding te verminder. Die uitslae van hierdie beskouing sal nietemin
met omsigtigheid geïnterpreteer moet word, weens die beperkte aantal
studies met die afwesigheid van klinies belangrike sekondêre
uitkomste in die ingeslote proewe. Verdere navorsing word benodig op
grootskaalse ewekansige beheerde proewe.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:sun/oai:scholar.sun.ac.za:10019.1/19984 |
| Date | 15 March 2012 |
| Creators | Seloka, Kelebogile Cynthia |
| Contributors | Khondowe, Oswell, Harper, Kim, Stellenbosch University. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Nursing Science. |
| Publisher | Stellenbosch : Stellenbosch University |
| Source Sets | South African National ETD Portal |
| Language | en_ZA |
| Detected Language | Unknown |
| Type | Thesis |
| Format | 85 p. : ill. |
| Rights | Stellenbosch University |
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