Available online 20 March 2023, 151740

Author links open overlay panel, , , , , , , , , , , , Abstract

The optimal cord management strategy at birth for each preterm baby is still unknown, despite more than 100 randomized controlled trials (RCTs) undertaken on this question. To address this, we brought together all RCTs examining cord management strategies at preterm birth in the iCOMP (individual participant data on COrd Management at Preterm birth) Collaboration, to perform an individual participant data network meta-analysis. In this paper, we describe the trials and tribulations around obtaining individual participant data to resolve controversies around cord clamping, and we derive key recommendations for future collaborative research in perinatology. To reliably answer outstanding questions, future cord management research needs to be collaborative and coordinated, by aligning core protocol elements, ensuring quality and reporting standards are met, and carefully considering and reporting on vulnerable sub-populations. The iCOMP Collaboration is an example of the power of collaboration to address priority research questions, and ultimately improve neonatal outcomes worldwide.

Section snippetsBackground

Each of the 15 million infants born preterm every year will have some form of umbilical cord management at birth. Choosing the right strategy may be a life-and-death decision for some.1 In addition to an increased survival probability, cord management strategies have been linked to improvements in the risk of major morbidities such as intraventricular hemorrhage and hypothermia.1,2 Yet, the important question of which strategy works best, and for whom, is still unresolved.1

A wide range of

Conclusion

Selecting the right cord management strategy at preterm birth may be a life-or-death decision. Encouragingly, the current trial landscape in this area is rich and vibrant. There are over 100 trials examining related research questions and many of those have committed to work together and share their data within the iCOMP Collaboration. The trials and tribulations of bringing together all these trials as described here leaves us with a number of recommendations, summarised in Figure 2, to ensure

Author contributions

All authors are members of the iCOMP secretariat and have, in monthly meetings over the past five years, uncovered all the presented challenges and recommendations in cord management research. ALS, KEH, AB, MA, SL, JW, NS, JA agreed in a consensus meeting on the structure of the manuscript, and all wrote parts of the first draft. ALS collated all initial parts into a comprehensive manuscript. All authors critically reviewed various drafts of the manuscript and approved the final version.

Uncited References

[52,40, 5,6, 53,7]

Disclosure

All authors are secretariat members of the iCOMP Collaboration. There are no financial conflicts of interest to disclose. The iCOMP Collaboration is funded by a National Health and Medical Research Council (NHMRC) Project Grant (GNT1163585). ALS is funded by an NHMRC Investigator grant (GNT2009432).

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